[1]冷雪艳,夏晓琼,陶志国,等.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[J].医学信息,2020,33(08):125-127.[doi:10.3969/j.issn.1006-1959.2020.08.040]
　LENG Xue-yan,XIA Xiao-qiong,TAO Zhi-guo,et al.Effect of Trendelenburg Position Combined with Pneumoperitoneum on Gynecological Laparoscopic Surgery[J].Medical Information,2020,33(08):125-127.[doi:10.3969/j.issn.1006-1959.2020.08.040]
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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()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年08期
页码:
125-127
栏目:
临床研究
出版日期:
2020-04-15

文章信息/Info

Title:
Effect of Trendelenburg Position Combined with Pneumoperitoneum on Gynecological Laparoscopic Surgery
文章编号:
1006-1959（2020）08-0125-03
作者:
冷雪艳; 夏晓琼; 陶志国; 等
（安徽医科大学附属巢湖医院麻醉科1，妇产科2，安徽 合肥 238000）
Author(s):
LENG Xue-yan; XIA Xiao-qiong; TAO Zhi-guo; et al
(Department of Anesthesiology1,Department of Obstetrics and Gynecology2,Chaohu Hospital,Anhui Medical University,Hefei 238000,Anhui,China)
关键词:
腹腔镜手术; 局部脑氧饱和度; 视神经鞘直径; 平均动脉压
Keywords:
Laparoscopic surgery; Local cerebral oxygen saturation; Optic nerve sheath diameter; Mean arterial pressure
分类号:
R713
DOI:
10.3969/j.issn.1006-1959.2020.08.040
文献标志码:
A
摘要:
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。
Abstract:
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.

参考文献/References:

[1]高腾猛.腹腔镜下子宫全切术与经腹子宫切除术治疗子宫良性疾病的疗效研究[J].实用妇科内分泌杂志,2017,4(22):64-65.[2]Kurazumi T,Ogawa Y,Yanagida R,et al.Dynamic cerebral autoregulation during the combination of mild hypercapnia and cephalad fluid shift[J].Aerosp Med Hum Perform,2017(88):819-826.[3]Kalmar AF,Dewaele F,Foubert L,et al.Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumo peritoneum[J].Br J Anaesth,2012(108):478-484.[4]Garrett ZK,Pearson J.Postural effects on cerebral blood flow and autoregulation[J].Physiological Reports,2017,5(4):e13150.[5]徐亮,张伟,尹荣真,等.围手术期超声测量视神经鞘直径预测颅内压增高的研究进展[J].国际麻醉学与复苏杂志,2018(5):468-472,504.[6]Chin JH,Seo H,Lee EH,et al.Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position[J].BMC Anesthesiol,2015(15):43.[7]Chen K,Wang L,Wang Q,et al.Effects of pneumoperitoneum and steep Trendelenburg position on cerebral hemodynamics during robotic-assisted laparoscopic radical prostatectomy:A randomized controlled study[J].Medicine,2019,98(21):e15794.[8]Naguib AN,Winch PD,Sebastian R,et al.The Correlation of Two Cerebral Saturation Monitors With Jugular Bulb Oxygen Saturation in Children Undergoing Cardiopulmonary Bypass for Congenital Heart Surgery[J].Journal of Intensive Care Medical,2016,32(10):603-608.[9]Antunes A,Montgomery D,Addison P.Correction of tissue oxygen saturations using arterial oxygen levels for cerebrovascular autoregulation analysis[J].Conference proceedings:Annual International Conference of the IEEE Engineering in Medicine and Biology Society.IEEE Engineering in Medicine and Biology Society.Annual Conference,2017(2017):4005-4008. [10]Matsuoka T,Ishiyama T,Shintani N,et al.Changes of cerebral regional oxygen saturation during pneumoperitoneum and Trendelenburg position under propofol anesthesia:a prospective observational study[J].BMC Anesthesiology,2019,19(1):72.

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更新日期/Last Update: 2020-04-15