妇科腹腔镜下不同CO2气腹压力对患者血流动力学的影响

The effects of different CO_2 insufflation pressure on hemodynamics during gynecological laparoscopic operation

目的探讨妇科腹腔镜手术中采用FloTrac/Vigileo系统监测下的CO_2气腹压力(IAP)对患者血流动力学的影响。方法选择拟行妇科腹腔镜手术的子宫肌瘤、卵巢囊肿患者66例,采用随机数字表法将其分为IAP10mmHg组、12mm Hg组和15mm Hg组,每组22例,采用FloTrac/Vigileo系统检测患者的血流动力学,并记录各监测指标的变化。结果三组患者麻醉后5min(T0)的心率、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)和每博输出量(SV)比较,差异均无统计学意义(P>0.05);三组气腹后1 min(T1)、气腹后5min(T2)、气腹后15 min(T3)患者的心率、MAP、CO与T0组比较,差异有统计学意义(P<0.05);15mm Hg组在T1、T2、T3的心率、MAP、CO波动较10 mm Hg组和12 mm Hg组患者显著(P<0.05)。15mm Hg组患者心律失常、呕吐等并发症发生率为31.82%(7/22),与10mm Hg组和12mm Hg组的4.55%(1/22)比较,差异有统计学意义(P<0.05)。结论妇科腹腔镜手术中不同CO_2气腹压力患者的血流动力学出现一定的波动,但是其压力在10mm Hg和12mm Hg波动范围较小,且手术并发症较低。

Objective To detect the effect of different pneumoperitoneum pressure on hemodynamics in gynecological laparoscopic operation monitored.Methods 66 cases of laparoscopic surgery for gynecological laparoscopic surgery including ovarian cyst removal and accessory surgery were divided into 22 groups,IAP10 mm Hg group,12 mm Hg group and 15 mm Hg group,hemodynamic fluctuations was monitored by FloTrac/Vigileo system.Result Patient＇s heart rate,mean arterial pressure（MAP）,cardiac output（CO）,cardiac index（CI）,the amount of output per Bo（SV）measured values,5min（T0）three groups after anesthesia had no statistically significant difference（P〈0.05）;The heart rate and MAP after 1min（T1）,5min（T2）and 15min（T3）of pneumoperitoneum was statistically significant difference compared with T0group（P〈0.05）.Patient＇s heart rate,MAP,CO volatility in 15 mm Hg group is bigger than 12 mm Hg and 10 mm Hg groups at T1,T2 and T3（P〈0.05）.Complication rate（31.82%）in 15 mm Hg group was significantly higher than 10 mm Hg group（4.55%）and12mm Hg group（4.55%）（χ2= 9.263,P〈0.05）.Conclusion Hemodynamic indexes in patients with CO2 during pneumoperitoneum will appear some fluctuations,10 mm Hg group and 12 mm Hg group had lower complication rate.