妇科腹腔镜手术中Trendelenburg体位合并气腹条件下患者脑血流变化的影响

Effect of Trendelenburg Position Combined with Pneumoperitoneum on Gynecological Laparoscopic Surgery

目的探讨妇科腹腔镜手术中Trendelenburg体位合并气腹条件下患者脑血流变化的影响因素。方法选取2018年1月~12月我院行腹腔镜下全子宫切除术患者60例,均在Trendelenburg体位合并气腹条件下术中连续监测rSO2、ONSD、MAP、CVP、HR、PETCO2和PaCO2指标,分析妇科腹腔镜手术中患者脑血流变化的影响及术中术后不良反应发生情况。结果左、右两侧rSO2、ONSD、MAP在T1~T4时点均高于T0时点,差异有统计学意义(P<0.05);左、右两侧rSO2、ONSD、MAP在T5时点高于T0时点,但差异无统计学意义(P>0.05)。CVP在T1~T5时点高于T0时点,差异有统计学意义(P<0.05)。PaCO2、PETCO2在T2~T5时点高于T0时点,差具有统计学意义(P<0.05);PaCO2、PETCO2在T1时点高于T0时点,但差异无统计学意义(P>0.05)。HR在T1、T5时点高于T0时点,在T2~T4时点低于T0,但差异无统计学意义(P>0.05)。术中3例患者麻醉诱导期出现低血压(MAP<60 mmHg),术后未发生镇痛不良及镇静过度现象等不良反应情况。结论在妇科腹腔镜手术中,Trendelenburg体位合并人工气腹导致患者大脑过度灌注,头低位即刻ICP一过性升高明显,但仍在脑自动调节范围内。患者脑血流的变化与MAP、CVP及PaCO2有关,与HR、SpO2的关系不明显。

Objective To investigate the influencing factors of cerebral blood flow changes in patients with Trendelenburg position and pneumoperitoneum during gynecological laparoscopic surgery.Methods Selecting 60 patients undergoing total laparoscopic hysterectomy in our hospital from January to December 2018,all of whom were continuously monitored for rSO2,ONSD,MAP,CVP,HR,PETCO2,and PaCO2 in the Trendelenburg position with pneumoperitoneum.Analyze the influence of changes in cerebral blood flow of patients during gynecological laparoscopic surgery and the occurrence of adverse reactions during and after surgery.Results The rSO2,ONSD,and MAP on the left and right sides were higher than T0 from T1 to T4,the difference was statistically significant(P<0.05);The rSO2,ONSD,and MAP on the left and right sides were higher at T5 than T0,but the difference was not statistically significant(P>0.05).CVP was higher than T0 from T1 to T5,the difference was statistically significant(P<0.05).PaCO2 and PETCO2 are higher than T0 when T2~T5,the difference was statistically significant(P<0.05);PaCO2 and PETCO2 are higher than T0 when T1,but the difference is not statistically significant(P>0.05).HR was higher than T0 at T1 and T5,and lower than T0 at T2~T4,but the difference was not statistically significant(P>0.05).During the operation,3 patients developed hypotension(MAP<60 mmHg)during induction of anesthesia,and no adverse reactions such as poor analgesia and excessive sedation occurred after operation.Conclusion In gynecological laparoscopic surgery,the Trendelenburg position combined with artificial pneumoperitoneum caused the patient's brain to be over-perfused,and the ICP transiently increased immediately after the head was lower,but it was still within the range of automatic brain adjustment.The changes of cerebral blood flow in the patients are related to MAP,CVP and PaCO2,but the relationship with HR and SpO2 is not obvious.