腔镜甲状腺手术CO2气腹对颈内静脉压力及中心静脉压的影响

摘要

Objective:To explore the effects of carbon dioxide insufflation on internal jugular vein pressure and central venous pressure during endoscopic thyroidectomy via a breast approach.Methods:The clinical data of 30 patients undergoing endoscopic thyroidectomy via a breast approach were analyzed.The internal jugular vein pressure and central venous pressure before carbon dioxide insufflation,10 min,20 min,40 min after insufflation and 5 min,20 min after exsufflation were measured and the pressure changes at different time point were compared.Results:The internal jugular vein pressure and central venous pressure after carbon dioxide insufflation were significantly increased than before insufflation (P<0.05).There was no significant difference of the pressure of internal jugular vein and central vein between after exsufflation and before insufflation (P>0.05).At three time points after carbon dioxide insufflation,the pressures of internal jugular vein were all greater than 8 mmHg (P<0.05),the pressures of central vein were all less than 8 mmHg (P<0.05).Conclusions:The jugular vein pressure and central venous pressure significantly increase after carbon dioxide insufflation during endoscopic thyroidectomy via breast approach.There is no possibility of air embolism during endoscopic medium and upper thyroidectomy,while gas embolism may occur in the lower part of the thyroid gland operation.%目的:探讨腔镜下胸乳入路甲状腺手术CO2气腹对颈内静脉压力及中心静脉压的影响.方法:30例患者经胸乳入路行腔镜下甲状腺手术,分别于CO2充气前,充气后10 min、20 min、40 min,关闭充气后5 min、20 min测量颈内静脉压力、中心静脉压,比较不同时点颈内静脉压力、中心静脉压的变化.结果:与充气前相比,充气后各时点的颈内静脉压力、中心静脉压显著上升(P<0.05);解除充气后,逐渐下降,与充气前相比差异无统计学意义(P>0.05);充气后三个时间点的颈内静脉压力均大于8 mmHg(P<0.05),中心静脉压均小于8 mmHg(P<0.05).结论:经胸乳入路腔镜甲状腺手术中CO2气腹会导致颈内静脉压力、中心静脉压显著升高,切除甲状腺中上部时无发生气体栓塞的可能,但切除甲状腺下部时有发生气体栓塞的可能.