【摘要】 目的观察不同体位腹腔镜手术时对呼吸、循环系统的影响及其临床意义。方法择期腹腔镜手术患者40例,并按需分为两组:A组20例,行头低足高体位;B组20例,行头高足低体位。两组均用咪达唑仑、芬太尼、维库溴铵、丙泊酚依次静注麻醉诱导,持续输注丙泊酚、间断追加维库溴铵维持麻醉。术中维持气腹压14mmHg。连续监测HR、BP、CVP,ECG、PETCO2、SpO2和Ppeak。分别于气腹前(T1)、气腹后调整至手术所需体位10min(T2)、20min(T3)及解除气腹后5min(T4)记录各数值用于比较分析。结果两组患者CVP气腹后较气腹前明显升高(P<0.01),且A组升幅明显高于B组(P<0.01)。气腹调整体位后10minHR较气腹前增快(P<0.01),此后略有减慢,B组解除气腹后降幅较大,与气腹后两时点比较差异有统计学意义(P<0.05)。气腹后BP、Ppeak明显升高(P<0.01);气腹后直至解除气腹后5min时PETCO2较气腹前均升高(P<0.01),而SpO2变化不明显(P>0.05)。两组间BP、Ppeak、PETCO2和SpO2比较差异无统计学意义(P>0.05)。结论腹腔镜手术时不同体位对CVP能够产生明显的影响,头低足高体位使CVP更大程度地升高,可能会对对心脏做功产生不利影响。更多还原

【Abstract】 Objective To observe the effects of different posture on respiratory and circulation system during laparoscopy.Methods Forty patients,scheduled for elective laparoscopy surgery under general anesthesia were included in this study.The patients were randomly allocated into two groups according to their posture during laparoscopy(n=20 for each group).In group A the patients were arranged in a head-down tilt position and in group B in a head-up tilt position according to the requirement of the operation.Anesthesia was induced with Midazolam,Fentanyl,Vecuronium and Propofol.After tracheal intubation,general anesthesia was maintained with propofol infusion and additional dose of vecuronium was given if necessary.HR,BP,CVP,ECG,PETCO2,SpO2 and Ppeak were monitored continuously and recorded before pneumoperitoneum(T1),after 10 minutes(T2)and 20 mintues(T3)when the patients were arranged in the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg,and at 5 minutes(T4)after deflation of pneumoperitoneum when the patients returned to supine position.Results In both groups,the CVP at T2 and T3 were significantly higher than that at T1(P<0.01)with a higher level in group A than in group B at the same time point during pneumoperitoneum(P<0.01).HR was higher at T2 than at T1 in both groups(P<0.01),then it was a little lower at T3 in both groups.HR at T4 in group B was obviously lower than those at T2 and T3(P<0.05).In both groups,BP and Ppeak increased significantly at T2 and T3(P<0.01).At the points of T2,T3 and T4,PETCO2 were increased significantly(P<0.01),but SpO2 had no obvious change(P>0.05).There were no significant differences in BP,Ppeak,PETCO2 and SpO2 at the same time point between two groups(P>0.05).Conclusion The posture may have obvious effect on CVP during pneumoperitoneum.The head-down and feet-up position can increas the CVP to a great extent accouting for many of the adverse effects on heart function.更多还原