中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
8期
959-961
,共3页
谢淑华%耿立成%高涛%王蕾
謝淑華%耿立成%高濤%王蕾
사숙화%경립성%고도%왕뢰
头低位%呼吸力学%脑血管循环%腹腔镜检查%结直肠外科手术
頭低位%呼吸力學%腦血管循環%腹腔鏡檢查%結直腸外科手術
두저위%호흡역학%뇌혈관순배%복강경검사%결직장외과수술
Head-down tilt%Respiratory mechanics%Cerebrovascular circulation%Laparoscoys%Colorectal surgery
目的 评价不同角度头低位对腹腔镜直肠癌根治术患者呼吸力学和脑循环的影响.方法 腹腔镜直肠癌根治术患者30例,年龄40～ 64岁,性别不限,ASA分级Ⅰ或Ⅱ级,体重指数＜30kg/m2.静脉注射咪达唑仑、芬太尼、异丙酚和顺阿曲库铵麻醉诱导,靶控输注异丙酚和瑞芬太尼,按需追加顺阿曲库铵维持麻醉.分别于平卧5 min、头低位30°5 min、头低位35°5 min、头低位40°5 min和气腹结束后30 min时,记录气道压(Paw)、气道峰压(PIP)、肺顺应性(Cpat)和颈静脉球部压力(JBP);采集桡动脉血样和颈静脉球血样,进行血气分析,记录动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、颈静脉球血氧分压(PjvO2)和颈静脉球血氧饱和度(SjvO2).结果 Paw、PIP、MAP、PaCO2、JBP、PjvO2和SjvO2较平卧位时升高,且随头低位角度的增大逐渐升高,气腹结束后30 min时降至平卧位时水平(P＜ 0.05);Cpat和PaO2较平卧位时降低,且随头低位角度的增大逐渐降低,气腹结束后30 min时升至平卧位时水平(P＜0.05).结论 腹腔镜直肠癌根治术时随头低位角度增加对患者呼吸力学和脑循环影响越大,因此此类手术患者头低位的适宜角度为小于40°.
目的 評價不同角度頭低位對腹腔鏡直腸癌根治術患者呼吸力學和腦循環的影響.方法 腹腔鏡直腸癌根治術患者30例,年齡40～ 64歲,性彆不限,ASA分級Ⅰ或Ⅱ級,體重指數＜30kg/m2.靜脈註射咪達唑崙、芬太尼、異丙酚和順阿麯庫銨痳醉誘導,靶控輸註異丙酚和瑞芬太尼,按需追加順阿麯庫銨維持痳醉.分彆于平臥5 min、頭低位30°5 min、頭低位35°5 min、頭低位40°5 min和氣腹結束後30 min時,記錄氣道壓(Paw)、氣道峰壓(PIP)、肺順應性(Cpat)和頸靜脈毬部壓力(JBP);採集橈動脈血樣和頸靜脈毬血樣,進行血氣分析,記錄動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2)、動脈血氧飽和度(SaO2)、頸靜脈毬血氧分壓(PjvO2)和頸靜脈毬血氧飽和度(SjvO2).結果 Paw、PIP、MAP、PaCO2、JBP、PjvO2和SjvO2較平臥位時升高,且隨頭低位角度的增大逐漸升高,氣腹結束後30 min時降至平臥位時水平(P＜ 0.05);Cpat和PaO2較平臥位時降低,且隨頭低位角度的增大逐漸降低,氣腹結束後30 min時升至平臥位時水平(P＜0.05).結論 腹腔鏡直腸癌根治術時隨頭低位角度增加對患者呼吸力學和腦循環影響越大,因此此類手術患者頭低位的適宜角度為小于40°.
목적 평개불동각도두저위대복강경직장암근치술환자호흡역학화뇌순배적영향.방법 복강경직장암근치술환자30례,년령40～ 64세,성별불한,ASA분급Ⅰ혹Ⅱ급,체중지수＜30kg/m2.정맥주사미체서륜、분태니、이병분화순아곡고안마취유도,파공수주이병분화서분태니,안수추가순아곡고안유지마취.분별우평와5 min、두저위30°5 min、두저위35°5 min、두저위40°5 min화기복결속후30 min시,기록기도압(Paw)、기도봉압(PIP)、폐순응성(Cpat)화경정맥구부압력(JBP);채집뇨동맥혈양화경정맥구혈양,진행혈기분석,기록동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、동맥혈양포화도(SaO2)、경정맥구혈양분압(PjvO2)화경정맥구혈양포화도(SjvO2).결과 Paw、PIP、MAP、PaCO2、JBP、PjvO2화SjvO2교평와위시승고,차수두저위각도적증대축점승고,기복결속후30 min시강지평와위시수평(P＜ 0.05);Cpat화PaO2교평와위시강저,차수두저위각도적증대축점강저,기복결속후30 min시승지평와위시수평(P＜0.05).결론 복강경직장암근치술시수두저위각도증가대환자호흡역학화뇌순배영향월대,인차차류수술환자두저위적괄의각도위소우40°.
Objective To evaluate the effects of different head-down tilt (HDT) angles on respiratory mechanics and cerebral circulation during laparoscopic radical resection of rectal carcinoma in the patients.Methods Thirty patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index ＜ 30 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were included in the study.Anesthesia was induced with midazolam,fentanyl,propofol and cis-atracurium and maintained with targetcontrolled infusion of propofol and remifentanil and cis-atracurium when needed.At 5 min after supine position,5 min after 30° HDT,5 min after 35° HDT,5 min after 40° HDT,and 30 min after pneumoperitoneum (T1-5),airway pressure (Paw),peak airway pressure (PIP),lung compliance (Cpat) and jugular bulb blood pressure (JBP) were recorded.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis and arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide in artery (PaCO2),arterial oxygen saturation (SaO2),jugular bulb oxygen partial pressure (PjvO2),and jugular bulb venous saturation (SjvO2) were recorded at each time point mentioned above.Results Paw,PIP,MAP,PaCO2,JBP,PjvO2 and SjvO2 were significantly increased as compared with those obtained when the patients were in supine position,increased gradually with the increasing HDT angles,and decreased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Cpat and PaO2 were significantly decreased as compared with those obtained when the patients were in supine position decreased gradually with the decreasing HDT angles,and increased to the level obtained when the patients were in supine position at 30 min after pneumoperitoneum.Conclusion HDT-induced effects on respiratory mechanics and cerebral circulation increase with increasing angles during laparoscopic radical resection of rectal carcinoma; thus the optimum HDT angle is smaller than 40° for the patients undergoing this kind of surgery.
