腹腔镜胃肠癌切除术中气腹对每搏量变异度及心血管功能的影响

摘要

Objective To observe the effect of pneumoperitoneum on stroke volume variability ( SVV) and cardi-ovascular function in patients undergoing laparoscopic resection of gastrointestinal cancer.Methods Patients scheduled for elective laparoscopic resection of gastrointestinal cancer were enrolled in the study.All patients received total intrave-nous anesthesia with propofol combined with sufentanil, remifentanil and muscle relaxant.Hemodynamic status was moni-tored with Flotrac/Vigileo and heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), SVV, systemic vascular resistance ( SVR) and Narcotrend index( NI) were recorded at the following time points, before induction of anes-thesia , before pneumoperitoneum , initiation of pneumoperitoneum, 10, 20, 50 minutes after pneumoperitoneum, and af-ter the pneumoperitoneum was exsufflated.Duration of surgery, volume of fluid infusion, urine output, volume of intraop-erative bleeding and red blood cell transfusion as well as anesthetics consumption were also recorded.Results Of the 68 patients enrolled, 42 cases needed intravenous infusion of nitroglycerin to control hypertension, although the depth of anes-thesia and NI were maintained at moderate levels during the laparoscopic surgery.SVV tended to decline at early stage of pneumoperitoneum( P<0.05) and returned to the levels similar to before pneumoperitoneum after 30 minutes.CI, MAP and SVR showed continuous elevation compared with those before induction of anesthesia(P<0.05).Conclusions SVV can be used as an indicator to estimate blood volume changes during laparoscopic resection of gastrointestinal cancer with pneumoperitoneum pressure between 12-13 mmHg.However, it seems difficult for anesthesia of propofol combined with sufentanil and remifentanil to prevent sympathetic response and blood pressure increase during pneumoperitoneum.%目的：观察腹腔镜胃肠癌切除手术中气腹对每搏量变异度（ SVV）及心血管功能的影响。方法对68例择期在腹腔镜下实施的胃肠癌手术患者采用丙泊酚复合舒芬太尼及瑞芬太尼麻醉及FloTrac／Vigileo血流动力学监测，观察麻醉前、气腹前、气腹开始后、气腹10 min、气腹20 min、气腹50 min、气腹结束后等时间点的心率、平均动脉压（MAP）、心脏指数（CI）、SVV、外周血管阻力（SVR）及Narcotrend指数（NI）等参数，同时记录手术时间、术中输液量、尿量、出血量、输血量及麻醉药用量等。结果68例患者中24例因术中血压升高而使用了硝酸甘油，麻醉手术过程NI值基本维持在中等麻醉深度水平。气腹开始后早期SVV值下降（P＜0.05），30 min后略回升到气腹前水平，而CI、MAP及SVR则持续明显升高，显著高于麻醉前（P＜0.05）。结论在气腹压12～13 mm-Hg腹腔镜胃肠癌手术中，SVV仍可作为容量监测指标反映容量变化，但单纯丙泊酚复合舒芬太尼和瑞芬太尼麻醉似乎难以防范气腹中的交感反应和血压升高。