异丙酚麻醉和腹腔镜胆囊切除术对血流动力学的影响

Hemodynamic Effects of Propofol Anesthesia and Laparoscopic Cholecystectomy

目的 :了解异丙酚麻醉和腹腔镜胆囊切除术 (LC)对血流动力学的影响。方法 :在 8例非肥胖ASAⅠ～Ⅱ级患者使用异丙酚 2mg/kg ,静脉诱导前、后 5和 10分钟CO2 气腹 (腹内压 0 6 7、1 33和 2kPa)、反向屈氏卧位后 5、2 0和 35分钟、放气后 2、15和 30分钟 ,分别测录MAP、肺动脉压、肺毛细血管楔压、CVP、心输出量 (热稀释法 )。计算出心脏指数、每搏指数、外周血管阻力、肺血管阻力、左室作功指数、右室作功指数。结果 :异丙酚诱导后心脏指数、每搏指数、左室作功指数下降 (P <0 0 1)。LC期间心脏指数下降 (P <0 0 5 ) ,外周血管阻力和CVP增加 (P <0 0 5 )。结论 :对于ASAⅠ～Ⅱ级的患者 ,异丙酚对心肌可有抑制作用。LC期间引起心肌抑制 ,静脉回流受阻 。

Objective: To investigate the hemodynamic effects of propofol anesthesia used for laparoscopic cholecystectomy(LC).Methods:8 nonobese ASA class Ⅰ or Ⅱ patients received propofol 20mg/kg iv anesthesia induction.The MAP,HR,PCWP,PAP,CVP and CO were measured before,at 5 and 10 min after induction,CO 2 pneumoperitonium (at LAP 067kPa,133kPa and 2kPa),at 5,20 and 30min after reverse Trendeleburg position, at 2,15 and 30 min after peritoneal defflation.Rusults:CI,SI,LVSWI were decreased after propofol induction,SVR and CVP were increased after LC while CI was decreased. All data returned to baseline at 30 min after defflation.Conclusion:Propofol might depress myocardial contractivity.CO 2 pneumoperitoneum might result in the obstacle of venous return and myocardial depression.