贵州医科大学学报

2015, v.40;No.176(05) 475-478+481

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经食道超声心动图评估腹腔镜胆囊切除术对冠状动脉血流的影响
Influence of Peritoneal Insufflation and Head-up Tilt Position during Laparoscopic Cholecystectomy on Coronary Artery Blood Flow Evaluated by Transesophageal Echocardiography

秦晨光;高鸿;翁浩;
QIN Chenguang;GAO Hong;WENG Hao;Guiyang Medical College;Department of Anesthesiology,Affiliated Hospital of Guiyang Medical College;Department of Anesthesiology,Fengxian District Center Hospital,Branch of Sixth Hospital Affiliated to Shanghai Jiaotong University;

摘要(Abstract):

目的:通过经食道超声心动图(transesophageal echocardiography,TEE)评价腹腔镜胆囊切除术中气腹和头高脚低位对冠状动脉血流量的影响。方法:选择ASA分级Ⅰ~Ⅱ级择期全身麻醉、头高脚低位下行腹腔镜下胆囊切除术患者27例,连续监测麻醉后10 min(T1),气腹后5 min(T2),改变体位后5 min(T3)、10 min(T4)及15 min(T5)时的心率(HR)、气道压(Paw)、呼气末二氧化碳分压(PETCO2)、平均动脉压(MAP),各时间点使用经食道超声技术测量冠状动脉左前降支(LAD)起始处直径(D)及速度时间微积分(VTI),并计算分钟血流量(Q)。结果:T2、T3、T4、T5各时间点Paw较T1明显上升(P<0.01);与T1时点相比,各时间点D及Q值显著减少(P<0.01);与T2时点相比,T3、T4、T5时点D及Q值显著减少(P<0.05);HR、MAP、PETCO2及VTI在各时点均无明显变化。结论:腹腔镜胆囊切除术气腹建立后冠状动脉血流量减少,头高脚低体位对冠状动脉血流量存在一定影响。
Objective: To evaluate the influence of peritoneal insufflation and head-up tilt position on coronary artery blood flow status by transesophageal echocardiography during laparoscopic cholecystectomy. Methods: A total of 27 patients of ASA classⅠorⅡ,scheduled for laparoscopic cholecystectomy surgery under the condition of head-up tilt position and general anesthesia were included in this study. Heart rate( HR),paw airway pressure( Paw),End-tidal carbon dioxide partial pressure( PET CO2),mean arterial pressure( MAP) were monitored continuously and recorded 10 min after the induction of anesthesia( T1),5 min after peritoneal insufflation( T2),5 min after trendelenburg position( T3),10 min after trendelenburg position( T4),and 15 min after trendelenburg position( T5),respectively. Diameters of the initiation of left anterior descending coronary arteries and the velocity-time integral( VTI) were measured by transesophageal echocardiography( TEE) and minute blood flow( Q) was also calculated and recorded at every time point. Results: Compared with T1,Paw at T2,T3,T4 and T5increased significantly( P < 0. 01). Compared with T1,diameters of the initiation of left anterior descending coronary arteries and minute blood flow at T2,T3,T4 and T5decreased significantly( P < 0. 01). Compared with T2,diameters of the initiation of left anterior descending coronary arteries and minute blood flow at T3,T4 and T5decreased( P < 0. 05). There was no significant change in HR,MAP,PETCO2 and VTI at every time points. Conclusions: The coronary artery blood flow is reduced after peritoneal insufflation during laparoscopic cholecystectomy and there is a certain effect of the head-up tilt position on coronary blood flow.

关键词(KeyWords): 胆囊切除术,腹腔镜;气腹;冠状动脉血流量;超声心动描记术,经食管
cholecystectomy,laparoscopic;pneumoperitoneum;coronary blood flow;echocardiography,transesophageal

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作者(Author): 秦晨光;高鸿;翁浩;
QIN Chenguang;GAO Hong;WENG Hao;Guiyang Medical College;Department of Anesthesiology,Affiliated Hospital of Guiyang Medical College;Department of Anesthesiology,Fengxian District Center Hospital,Branch of Sixth Hospital Affiliated to Shanghai Jiaotong University;

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DOI: 10.19367/j.cnki.1000-2707.2015.05.013

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