CAJ | 학술논문

目的：探讨 FloTrac／Vigileo 监测下不同体位对腹腔镜阑尾切除术患者血流动力学的影响。方法拟行腹腔镜阑尾切除术患者60例，随机分为三组，每组20例，手术时分别为头低脚高位10°（A 组）、20°（B 组）和30°（C 组）。麻醉前行左桡动脉穿刺连接 FloTrac／Vigileo 系统。记录气腹前（T0）、气腹后1 min（T1）、5 min 稳定后改变体位时（T2）、气腹后20 min（T3）、气腹结束后1 min （T4）及5 min 稳定后恢复体位时（T5）的 HR、MAP、心输出量（CO）、心脏指数（CI）和每搏量（SV），并记录气腹时间和手术时间。结果与 T0时比较，T1～T3时三组 HR 明显增快，MAP 明显升高（P＜0.05）；与 T1时比较，T2、T3时 C 组 CO 及 SV 明显升高（P＜0.05）。与 C 组比较，T2、T3时 A、B 组CO 及 SV 明显降低（P＜0.05）。与 C 组比较，A、B 组气腹时间及手术时间明显延长（P＜0.05）。结论头低脚高位30°下行腹腔镜阑尾切除手术，患者血流动力学的变化在临床安全范围内，且手术时间及气腹时间较10°和20°短。
목적：탐토 FloTrac／Vigileo 감측하불동체위대복강경란미절제술환자혈류동역학적영향。방법의행복강경란미절제술환자60례，수궤분위삼조，매조20례，수술시분별위두저각고위10°（A 조）、20°（B 조）화30°（C 조）。마취전행좌뇨동맥천자련접 FloTrac／Vigileo 계통。기록기복전（T0）、기복후1 min（T1）、5 min 은정후개변체위시（T2）、기복후20 min（T3）、기복결속후1 min （T4）급5 min 은정후회복체위시（T5）적 HR、MAP、심수출량（CO）、심장지수（CI）화매박량（SV），병기록기복시간화수술시간。결과여 T0시비교，T1～T3시삼조 HR 명현증쾌，MAP 명현승고（P＜0.05）；여 T1시비교，T2、T3시 C 조 CO 급 SV 명현승고（P＜0.05）。여 C 조비교，T2、T3시 A、B 조CO 급 SV 명현강저（P＜0.05）。여 C 조비교，A、B 조기복시간급수술시간명현연장（P＜0.05）。결론두저각고위30°하행복강경란미절제수술，환자혈류동역학적변화재림상안전범위내，차수술시간급기복시간교10°화20°단。
Objective To investigate the effect of the different position on hemodynamic moni-tored by FloTrac/Vigileo system in patients undergoing laparoscopic appendectomy.Methods Sixty patients undergoing laparoscopic appendectomy,ASA Ⅰ or Ⅱ,were randomly divided into three groups (n=20):group A,B and C underwent the trendelenburg position of 10 degrees,20 degrees and 30 degrees,respectively.HR,MAP,cardiac output (CO),cardiac index (CI)and stroke volume (SV)were recorded before pneumoperitoneum (T0 ),1 min after pneumoperitoneum (T1 ),5 min af-ter trendelenburg position (T2 ),20 min after pneumoperitoneum (T3 ),1 min after the end of pneu-moperitoneum (T4 )and 5 min after the end of trendelenburg position (T5 )after induction of anesthe-sia.The time of pneumoperitoneum and operation was recorded.Results Compared with T0 ,HR and MAP increased significantly at T1-T3 in three groups(P<0.05);Compared with group C,CO and SV decreased significantly at T2-T3 in group A and group B (P<0.05).Compared with T1 ,CO and SV increased at T2-T3 in group C (P<0.05).Compared with group C,the time of pneumoperitoneum and operation was longer in group A and B (P<0.05).Conclusion During the operation of laparo-scopic appendectomy,the change of the hemodynamic is in clinical safe range,and the time of pneu-moperitoneum and operation is shorter in the position of 30°than 10°and 20°in laparoscopic appen-dectomy.