CAJ | 학술논문

目的：妇科腹腔镜手术为了操作方便常采用头低脚高位，本研究为了解CO2气腹时，头低脚高位对血流动力学的影响。方法选择20位ASA I级的妇科腹腔镜的健康女患者，以瑞芬太尼和丙泊酚诱导插管和维持。监测心率、动脉收缩压、舒张压、平均动脉压、心排量、心指数、每搏量、每搏指数、每搏变异。监测点：创建气腹前，平躺时(T 0)，头低15度时(T 1)，头低30度时(T 2)，创建气腹后（气腹压12 mmHg），平躺时（T 0～0），头低15度时（T0～1），头低30度时（T0～2）。结果腹腔充气前，平卧位，头低脚高位15度和30度三个时点，各项血流动力学参数有变化，与T0时比较，T1和T2二组MAP、CO、CL、SV和SVI明显升高（P<0.05）；HR和SVV降低（P<0.05）。腹腔充气后，平卧位，头低脚高位15度和30度三个时点，各项血流动力学参数也有变化，与T0时比较，T1和T2二组SAP、DAP、CO、CL、SV和SVI明显升高（P<0.05）；HR和SVV降低（P<0.05）。结论妇科腹腔镜手术头低脚高位后对循环系统中各项血流动力学参数有明显变化。妇科腹腔镜手术时为了保证患者的安全不应过度的头低脚高位。
목적：부과복강경수술위료조작방편상채용두저각고위，본연구위료해CO2기복시，두저각고위대혈류동역학적영향。방법선택20위ASA I급적부과복강경적건강녀환자，이서분태니화병박분유도삽관화유지。감측심솔、동맥수축압、서장압、평균동맥압、심배량、심지수、매박량、매박지수、매박변이。감측점：창건기복전，평당시(T 0)，두저15도시(T 1)，두저30도시(T 2)，창건기복후（기복압12 mmHg），평당시（T 0～0），두저15도시（T0～1），두저30도시（T0～2）。결과복강충기전，평와위，두저각고위15도화30도삼개시점，각항혈류동역학삼수유변화，여T0시비교，T1화T2이조MAP、CO、CL、SV화SVI명현승고（P<0.05）；HR화SVV강저（P<0.05）。복강충기후，평와위，두저각고위15도화30도삼개시점，각항혈류동역학삼수야유변화，여T0시비교，T1화T2이조SAP、DAP、CO、CL、SV화SVI명현승고（P<0.05）；HR화SVV강저（P<0.05）。결론부과복강경수술두저각고위후대순배계통중각항혈류동역학삼수유명현변화。부과복강경수술시위료보증환자적안전불응과도적두저각고위。
Objective Trendelenburg position is often used in gynecological laparoscopic surgery,we therefore studied the effects on the hemodynamics in Trendelenburg position when carbon dioxide pneumoperitoneum happens.Methods 20 ASA class I gynecological laparoscopy healthy female patients with remifentanil and propofol induced intubation and maintaining were studied. The heart rate, systolic arterial pressure (SAP), diastolic pressure, mean arterial pressure, cardiac output, cardiac index, stroke volume, stroke volume index and stroke volume variation(Bispectral index,BIS) were monitored. Monitoring points before pneumoperitoneum was created, when lying down (T0), when head 15 degrees lower (T1), when head 30 degrees lower (T0);After pneumoperitoneum created (gas abdominal pressure 12mmHg) when lying down (T0-0), when head 15 degrees lower (T0-1), when head 30 degrees lower (T0-2).Results There was some differences before carbon dioxide pneumoperitoneum happened in the hemodynamic parameters at three time points, namely 15 degrees, 30 degrees and in supine position. Compared with T0 group, MAP、CO、CL、SV and SVI in T1 and T2 groups increased significantly (P<0.05), and HR and SVV decreasing instead (P<0.05). When carbon dioxide pneumoperitoneum was created, there were also significant differences in hemodynamic parameters. Compared with T0 group, SAP、DAP、CO、CL、SV and SVI in T1 and T2 groups increased significantly (P<0.05), and HR and SVV decreasing instead (P<0.05).Conclusion There are significant changes of hemodynamic parameters in the Tendelenburg position. Patients should not be in Trendelenburg position unduly for their safety in the gynecological laparoscopic surgery.