中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
20期
15-17
,共3页
麻醉,全身%气腹,人工%体位%中心静脉压%心钠素
痳醉,全身%氣腹,人工%體位%中心靜脈壓%心鈉素
마취,전신%기복,인공%체위%중심정맥압%심납소
Anaesthesia,general%Pneumoperitoneum,artificial%Posture%Central Venous pressure%Atrial natriuretic factor
目的 观察不同体位腹腔镜手术时血流动力学及血浆心钠素(ANP)的变化,并探讨其临床意义.方法 择期腹腔镜手术患者40例,依据术中所需体位分为两组:A组20例,行头低足高体位;B组20例,行头高足低体位.两组麻醉方法 相同.分别于气腹前(T1)、气腹压力稳定在14mm Hg(1 mm Hg=0.133 kPa)且调整体位后10 min(T2)、20 min(T3)及解除气腹后5 min(T4)监测中心静脉压(CVP)、收缩压(SBP)、舒张压(DBP)及心电图(ECG),同时经中心静脉抽取静脉血,放免法测定血浆中ANP含量.结果 A组T2、T3时点CVP[(14.45±2.72)、(14.20±2.46)mm Hg]和B组T2、T3时点CVP[(8.90±1.27)、(9.02±1.47)mm Hg]与T1时点[(6.05±1.76)、(6.30±1.34)mm Hg]比较明显升高(P<0.01);A组T2、T3时点CVP升高幅度明显高于B组,差异有统计学意义(P<0.01).A组ANP在T2时点较T1时点略升高,至T3时点显著增高(P<0.05).两组间T2、T3时点ANP比较差异有统计学意义(P<0.05).结论 腹腔镜手术时不同体位对CVP、ANP能够产生明显的影响.
目的 觀察不同體位腹腔鏡手術時血流動力學及血漿心鈉素(ANP)的變化,併探討其臨床意義.方法 擇期腹腔鏡手術患者40例,依據術中所需體位分為兩組:A組20例,行頭低足高體位;B組20例,行頭高足低體位.兩組痳醉方法 相同.分彆于氣腹前(T1)、氣腹壓力穩定在14mm Hg(1 mm Hg=0.133 kPa)且調整體位後10 min(T2)、20 min(T3)及解除氣腹後5 min(T4)鑑測中心靜脈壓(CVP)、收縮壓(SBP)、舒張壓(DBP)及心電圖(ECG),同時經中心靜脈抽取靜脈血,放免法測定血漿中ANP含量.結果 A組T2、T3時點CVP[(14.45±2.72)、(14.20±2.46)mm Hg]和B組T2、T3時點CVP[(8.90±1.27)、(9.02±1.47)mm Hg]與T1時點[(6.05±1.76)、(6.30±1.34)mm Hg]比較明顯升高(P<0.01);A組T2、T3時點CVP升高幅度明顯高于B組,差異有統計學意義(P<0.01).A組ANP在T2時點較T1時點略升高,至T3時點顯著增高(P<0.05).兩組間T2、T3時點ANP比較差異有統計學意義(P<0.05).結論 腹腔鏡手術時不同體位對CVP、ANP能夠產生明顯的影響.
목적 관찰불동체위복강경수술시혈류동역학급혈장심납소(ANP)적변화,병탐토기림상의의.방법 택기복강경수술환자40례,의거술중소수체위분위량조:A조20례,행두저족고체위;B조20례,행두고족저체위.량조마취방법 상동.분별우기복전(T1)、기복압력은정재14mm Hg(1 mm Hg=0.133 kPa)차조정체위후10 min(T2)、20 min(T3)급해제기복후5 min(T4)감측중심정맥압(CVP)、수축압(SBP)、서장압(DBP)급심전도(ECG),동시경중심정맥추취정맥혈,방면법측정혈장중ANP함량.결과 A조T2、T3시점CVP[(14.45±2.72)、(14.20±2.46)mm Hg]화B조T2、T3시점CVP[(8.90±1.27)、(9.02±1.47)mm Hg]여T1시점[(6.05±1.76)、(6.30±1.34)mm Hg]비교명현승고(P<0.01);A조T2、T3시점CVP승고폭도명현고우B조,차이유통계학의의(P<0.01).A조ANP재T2시점교T1시점략승고,지T3시점현저증고(P<0.05).량조간T2、T3시점ANP비교차이유통계학의의(P<0.05).결론 복강경수술시불동체위대CVP、ANP능구산생명현적영향.
Objective To observe the effects of different posture on hemodynamics and plasma atrial natriuretic polypeptide(ANP) during laparoscopic surgery. Methods Forty patients who scheduled for elective laparoscopic surgery under general anesthesia were allocated into two groups according to their posture during laparoscopic surgery,20 cases for each group. In group A, the patients were arranged in a head-down tilt position, in group B, the patients were arranged in a head-up tilt position systolic blood pressure (SBP),diastolic blood pressure (DBP),central venous pressure (CVP) and electro cardio gram (ECC) were monitored continuously. Blood samples were taken from central venous at four time points of prepneumoperitoneum(T1), 10 minutes after that(T2) and 20 mintues(T3) when the patients were arranged at the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg (1 mm Hg = 0.133 kPa),and at 5 minutes (T4) after deflation of pneumoperitoneum when the patients returned to supine position. The plasma ANP was assessed by radioimmunoassay. Results In group A,the CVP at T2 and T3 [(14.45 ±2.72),(14.20 ±2.46) mm Hg] was significantly higher than that at T1 [(6.05 ±1.76) mm Hg] (P<0.01), in group B,the CVP at T2 and T3 [(8.90±1.27),(9.02 ±0.47) mm Hg] was significantly higher than that at T1[(6.30 ±1.34) mm Hg](P< 0.01) ,with a higher level in group A than those in group B at the same time point during pneumoperitoneum(P< 0.01). The ANP level in group A was higher at T2 than that at T1, and there was significantly higher at T3 than that at T1 (P < 0.05). But the ANP level was significantly higher in group A than that in group B at the same time points of T2 and T3 (P < 0.05). Conclusion The posture may have obvious effect on CVP and plasma ANP level during laparoscopic surgery.
