气腹压变化对腹腔镜胆囊切除术老年患者颈动脉血流的影响

Effect of Changes in Pneumoperitoneum Pressure on Carotid Blood Flow in Elderly Patients Undergoing Laparoscopic Cholecystectomy

目的经颈动脉多普勒超声(carotid doppler ultrasound,CDU)评估气腹压(pneumoperitoneum pressure,PP)变化对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)老年患者颈动脉血流量的影响。方法选择2022年12月至2023年9月在内蒙古自治区人民医院行择期LC的患者90例。随机分为S1组、S2组和S3组,设置PP分别为10 mm Hg、12 mm Hg和14 mm Hg。在麻醉前(T_(1))、插管后2 min(T_(2))、PP建立后2 min(T_(3))和PP结束后2 min(T_(4)),利用CDU测量患者颈总动脉(common carotid artery,CCA)左右侧直径和血流量。测量时患者均为水平仰卧位。同时记录患者心率(heart rate,HR)和平均动脉压(mean arterial pressure,MAP)。结果与T_(1)时比较,T_(2)~T_(4)时各组CCA左右侧直径及左右侧血流量均降低(P<0.05)。与T_(2)时比较,T_(3)时各组CCA左右侧血流量均降低(P<0.05)。与S1组比较,T_(3)时S3组CCA左右侧血流量降低(P<0.05)。与T_(1)时比较,T_(2)~T_(4)叶各组MAP均降低(P<0.05);与T_(2)时比较,T_(3)时S2组和S3组MAP均升高(P<0.05);与T_(3)时比较,T_(4)时S2组和S3组MAP均降低(P<0.05)。与S1组比较,T_(3)时其余各组MAP均升高(P<0.05),T_(4)时S3组MAP升高(P<0.05);与S2组比较,T_(3)~T_(4)时S3组MAP升高(P<0.05)。结论PP变化对LC老年患者颈动脉血流的影响有差异,S1组和S2组对LC老年患者颈动脉血流量的影响小于S3组。

Objective The effect of changes in pneumoperitoneum pressure(PP)on carotid blood flow in elderly patients undergoing laparoscopic cholecystectomy(LC)was assessed by transcarotid doppler ultrasound(CDU).Methods Ninety patients who underwent elective LC at the Inner Mongolia Autonomous Region from December 2022 to September 2023 were selected,They were randomly divided into groups S1,S2 and S3,and the PP was set at 10 mm Hg,12 mm Hg and 14 mm Hg,respectively.The right and left lateral diameters and blood flow of the patients'common carotid artery(CCA)were measured using a CDU before anesthesia(T1),2 min after intubation(T2),2 min after the establishment of PP(T3),and 2 min after the end of PP(T4).The patients were in horizontal supine position during the measurements.Heart rate(HR)and mean arterial pressure(MAP)were also recorded.Results Compared with that at T1,the right and left lateral diameters and blood flow of CCA were reduced in all groups at T2-T4(P<0.05).compared with that at T2,the left and right lateral blood flow of CCA was reduced in all groups at T3(P<0.05).Compared with the S1 group,the left and right side blood flow of CCA was reduced in the S3 group at T3(P<0.05).Compared with that at T1,MAP was lower in all groups at T2-T4(P<0.05);compared with that at T2,MAP was higher in both the S2 and S3 groups at T3(P<0.05);compared with that at T3,MAP was lower in both the S2 and S3 groups at T4(P<0.05).Compared with the S1 group,MAP was elevated in the remaining groups at T3(P<0.05)and in the S3 group at T4(P<0.05);compared with the S2 group,MAP was elevated in the S3 group at T3-T4(P<0.05).Conclusions There was a difference in the effect of P changes on carotid blood flow in elderly patients with LC,with groups S1 and S2 having a smaller effect on carotid blood flow in elderly patients with LC than group S3.