FloTrac/Vigileo系统监测不同气腹压对幼儿腹腔镜疝气手术围术期血流动力学的影响

Effect of different pneumoperitoneum pressures on perioperative hemodynamics of infants undergoing laparoscopic hernia surgery with FloTrac/Vigileo system

目的观察不同的气腹压力对幼儿腹腔镜疝气手术围术期心输出量的变化及血流动力学的影响。方法采用FloTrac/Vigileo系统研究幼儿腹腔镜疝气手术围术期心输出量的变化。90例患儿随机分为三组,每组患儿30例,A组术中气腹压8 mmHg;B组气腹压10 mmHg;C组气腹压12 mmHg。分别记录患儿吸入七氟烷后静卧3 min后(T0)、患儿气管插管后5min(T1)、气腹后1 min(T2)、气腹后5 min改变体位时(T3)、气腹后10 min(T4)、气腹结束后1 min(T5)、气腹结束后5 min(T6)及手术结束拔管后5 min(T7)各个时间点的心输出量、HR和MAP,观察并记录相关的术中、术后并发症。结果三组患儿气腹后HR、MAP均较气腹前明显升高(P<0.05),而心输出量气腹前后无明显差异。结论对于20 min内的短小腔镜手术,采用8-12 mmHg均对患儿心输出量无明显影响。

Objective To explore the effects of different pneumoperitoneum pressures on the perioperative cardiac output and hemodynamics in infants undergoing laparoseopic hernia operation with the FloTrac/Vigileo system. Methods Ninety patients were randomly divided into three groups（30 in each group）. The pneumoperitoneum pressure was set at 8 mmHg, 10 mmHg and 12 mmHg in groups A, B, C, respectively. The cardiac output, HR and MAP were recorded 3 min after inhalation of seven halothane （TO ） ,5min after trachea intubation （ T1 ）, 1 min after giving pneumoperitoneum （ T2 ） ,5 min after giving pneumoperitoneum （ T3 ） , 10 min after giving pneumoperitoneum （ T4 ）, 1 min after pneumoperitoneum ending（ T5 ） ,5 rain after pneumoperitoneum ending（ T6 ） and the 5min after extubation （T7 ）. Meanwhile, the operative and postoperative complications were recorded. Results HR and MAP in each group increased significantly after giving artificial pneumoperitoneum（ P 〈 O. 05 ）, while the cardiac output showed no significant difference before and after artificial pneumoperitoneum. Conclusion As for laparoscopic hernia surgery within 20 min, the pneumoperitoneum pressure of 8 - 12 mmHg could not influence the cardiac output.