液体治疗对妇科患者腹腔镜手术时血流动力学的影响

Influence of preemptive intravenous fluid infusion on hemodynamics during laparoscopic gynecologic surgery

目的探讨液体治疗对妇科患者腹腔镜手术时血流动力学的影响。方法选择ASAⅠ级的妇科腹腔镜手术患者20例,随机均分为胶体液组(A组)和晶体液组(B组),麻醉前分别输注6%羟乙基淀粉130/0.4氯化钠注射液和复方乳酸钠注射液。两组患者均以瑞芬太尼和依托咪酯诱导插管和维持。记录平卧位(T1)、头低20°(T2)、手术开始时(T3)、CO2气腹压为12mmHg平卧位(T4)、CO2气腹压为12mmHg时的头低20°(T5)、CO2气腹压力15mmHg时平卧位(T6)、CO2气腹压为15mmHg头低20°(T7)以及CO2气腹压为15mmHg时头低20°持续10min(T8)、20min(T9)的SBP、DBP、HR、CO、每搏输出量(SV)、每搏量变异(SVV)。结果与T1时比较,T4～T7时两组SBP、DBP、SV均明显升高(P<0.05)。与T2时比较,T5～T7时两组SBP、DBP、SV明显升高(P<0.05)。与T7时比较,T9时A组、T8、T9时B组SBP、DBP和SV明显降低、HR明显增快(P<0.05)。与B组比较,T8、T9时A组SBP、DBP和SV明显升高、HR明显减慢(P<0.05)。结论腹腔镜下CO2气腹对患者的循环影响较大,麻醉前的液体治疗可以减少CO2气腹对循环的影响,其中胶体液治疗效果更好。

Objective To investigate the influence of preemptive intravenous fluid infusion on hemodynamics during laparoscopic gynecologic surgery. Methods Twenty women with ASA I undergoing gynecological laparoscopy were randomized into two intravascular fluid groups： colloid group（group A） and crystal group （group B）, sodium chloride hydroxyethyl starch 130/0.4 and sodium lactate ringer solution were given, respectively. All patients were induced and maintained with remifentanil and etomidate plus vecuronium. SBP, DBP, FIR, CA）, SV, SVV and BIS were monitored and obtained without or in the presence of 12 mm Hg or 15 mm Hg pressure of CCh pneumoperitoneum combined with supine position or 20 degrees Trendelenburg position for 10 min and 20 mir~ Results Compared with T1, SBP,DBP and SV were increased significantly at T4-T7 in both groups（P% 0. 05）. Compared with T2, SBP,DBP and SV were increased significantly at Ts-T7 in both groups（P~ 0. 05）. Compared with T7 ,SBP,DBP,SV, HR in group A at T9 and in group B at T8 ,T9 were decreased（P d0. 05）. Compared with group B, SBP, DBP and SV at Ts, T9 in group A were increased and HR were slower significantly（P%0. 05）. There was no difference with BIS at each time point in the two groups. Conclusion The COz pneumoperitoneum is the primary cause of the hemodynamic changes in laparoscopic surgery. Preemptive intravenous fluid infusion can reduce the impact of CO2 pneumoperitoneum on hemodynamics, which was more effective with the colloid treatment.