腹腔镜手术体位对脑血管阻力及血流量的影响

Effect of positions on cerebral vascular resistance index andarterial blood flow volume during laparoscopic surgery

目的探讨腹腔镜手术体位对脑血管阻力及血流量的影响。方法选取2020年1~7月在皖南医学院第一附属医院择期行腹腔镜手术的女性患者60例,按随机数字表法,分为试验组(T组)与对照组(R组),每组30例。试验组按术中体位需要调整为头低位(-30°),对照组为头高位并向左侧倾斜(30°)。采用无创多普勒超声测量,比较T_(1)(置入喉罩后5分钟)、T_(2)(气腹体位变化后即刻)、T_(3)(气腹体位变化30分钟)、T_(4)(关气腹体位恢复后10分钟)4个时间点双侧颈内动脉和椎动脉血管阻力指数(RI)的差异,并对两组患者脑动脉血流量(CBFV)进行分析。观察比较两组患者T_(1)~T_(4)4个时点心率(HR)、平均动脉压(MAP)和呼气末二氧化碳分压(PETCO_(2))的差异。结果两组患者双侧颈内动脉和椎动脉RI组间比较,差异有统计学意义(P<0.05),存在时间、交互效应。在T_(2)~T_(4)时,T组双侧椎动脉和颈内动脉RI高于R组(P<0.05);与T_(1)比较,在T_(2)~T_(3)时点,T组右椎动脉和左颈内动脉RI增高(P<0.05)。两组患者CBFV组间比较,差异无统计学意义(P>0.05);在T_(2)时,T组CBFV高于R组(P<0.05);与T_(1)比较,在T_(2)和T_(3)时点,T组CBFV增加(P<0.05)。两组患者HR、MAP、PETCO_(2)组间比较,差异无统计学意义(P>0.05)。在T_(3)时点,T组MAP高于R组(P<0.05);与T_(1)比较,在T_(2)~T_(4)时点,T组MAP增加(P<0.05)。结论腹腔镜手术中头低位可引起椎动脉和颈内动脉血管阻力指数及血流量增加。

Objective To investigate the effect of positions on cerebral vascular resistance index andarterial blood flow volume during laparoscopic surgery.Methods Sixty female patients who underwent laparoscopic surgery in the First Affiliated Hospital of Wannan Medical College from January to July 2020 were selected as the research objects.According to the random number table method,they were divided into the experimental group(Group T)and the control group(Group R).Group T was adjusted to the Trendelenburg position(-30°)according to the need of intraoperative various position;Group R was the reverse-Trendelenburg position with left tilting(30°),with 30 cases in each group.The resistance index of the internal carotid arteries and vertebral arteries and the cerebral arterial blood flow volumewere measured with Doppler ultrasound at the following time points:T_(1)(5 minutes after insertion of the laryngeal mask),T_(2)(position change 0 minute),T_(3)(30 minutes after position change),T_(4)(10 minutes after recovery horizontal position).HR,MAP and PETCO_(2) were observed and compared between the two groups at T_(1)~T_(4).Results The resistance index of bilateral internal carotid arteries and vertebral arteries were significantly different between the two groups(P<0.05),and there were time and interaction effects.The resistance index of the bilateral internal carotid arteries and vertebral arteries in Group T was higher than that in Group R at T_(2)~T_(4)(P<0.05).Compared with T_(1),the resistance index of the right vertebral arteries and left internal carotid arteries was higher in group T at T_(2)~T_(3).There was no significant difference in the cerebral arterial blood flow volume between the two groups(P>0.05).The cerebral arterial blood flow volume of group T was significantly higher than that of group R patients at T_(2)(P<0.05).Compared with T_(1),the cerebral arterial blood flow volume of group T significantly increased at T_(2) and T_(3)(P<0.05).There was no significant difference in HR,MAP and PETCO2 between the two groups(P>0.05).At T_(3),the MAP of Group T was significantly higher than Group R(P<0.05).Compared with T_(1),the MAP of Group T increased significantly at T_(2)~T_(4)(P<0.05).Conclusions During laparoscopic surgery,Trendelenburg position can causes the increase ofresistance index of the vertebral artery and internal carotid artery and the cerebral arterial blood flow volume.