不同截石位改变速度及不同气腹压力对妇科腹腔镜手术患者的影响

Effect on gynecological laparoscopic patients by various lithotomy position speeds and various pneumoperitoneum pressures

目的探讨不同截石位改变速度、不同气腹压力对妇科腹腔镜手术患者血流动力学和气道峰压的影响。方法将2012年2～8月在我院行妇科腹腔镜手术的112例患者随机分为四组。试验组1:气腹压力11mmHg,变换体位速度大于30s;试验组2:气腹压力14mmHg,变换体位速度大于30s;试验组3:气腹压力11mmHg,变换体位速度小于6s。对照组:气腹压力14mmHg,变换体位速度小于6s。分别监测四组在建立气腹前、建立气腹后、改变体位后、拔除气腹前、拔除气腹后、恢复体位后不同时间点收缩压、舒张压、平均动脉压、心率、呼气末CO2、气道峰压。结果与气腹前相比,四组患者收缩压、舒张压、平均动脉压在气腹后显著增加,拔除气腹或恢复截石位后逐渐恢复正常,其中试验组增加幅度减少,试验组之间差异无显著意义。四组心率无显著差异。四组呼气末二氧化碳在气腹后呈现增加趋势,试验组呼气末二氧化碳在气腹后增加程度减少,其中,试验组1患者呼气末二氧化碳无显著变化。四组患者气道峰压在气腹后显著增加,各组之间差异无显著意义。结论减慢术中变换体位的速度、在保证手术膨腹效果的基础上降低气腹的压力,可减少对患者血流动力学的影响,降低气道峰压,有利于老年和伴有心肺疾患患者的康复。

Objective To investigate effect on hemodynamics and peak airway pressure for gynecological laparo scopic patients by various patient disposition speeds and various CO2 pneumoperitoneum pressures. Method 112 gy necological patients underwent laparoscopic surgeries from February 2012 to August 2012 in our hospital were ran domly divided into 4 groups according to various pneumoperitoneum pressures and various duration of patient pos ture changing. Group 1.. pneumoperitoneum pressure was 11 mmHg and the duration of patient posture changing was more than 30 seconds. Group 2 ： the pneumoperitoneum pressure was 14 mmHg and the duration of patient pos ture changing was more than 30 seconds. Group 3： pneumoperitoneum pressure was 11 mmHg and the duration of patient posture changing was less than 6 seconds. Control group： pneumoperitoneum was 14 mmHg and the dura tion of patient posture changing was less than 6 seconds. The hemodynamics, peak air way pressure, end tidal CO2 were recorded before and after peumoperitoneum, postTrendelenburg position, lmins before and after peumoperito neum, during lithotomy position recovered from Trendelenburg position. Result SBP, DBP and MAP increased afte~ the onset of peumoperitoneum and did not decreased until the end of peumoperitoneum or recovery of patients tren delenburg position in the four groups with lower significance in the experimental groups. There was no difference in HR in the four groups. The end tidal CO2 increased after the onset of peumoperitoneum in the four groups with low er significaneently in the experimental groups. The peak air way pressure increased after the onset of peumoperitone um without difference among the groups. Conclusion The hemodynamics will be stable and peak air way pressure will be decreased in decreased peumoperitoneum pressure and （or） slower trendelenburg position changing. It is benefi cial for the aged patients and those patients with cardiovascular or pulmonary disease.