腹腔镜手术中血流动力学的改变

摘要

Laparoscopic surgery has been widely popularized in clinic for its unique advantages. Under the influence of pneumoperitoneum,position and anesthesia,the hemodynamics in operation changes remark-ably. Pneumoperitoneum can induce the rise of PaCO2 level( hypercapnia ), and with the increasing of intra-abdominal pressure(IAP),the lung compliance decrease and the obvious hemodynamic change are caused. The extent of the hemodynamic change depends on IAP and basic hemodynamic state. As pneumoperitoneum appears,the mean arterial pressure and peripheral vascular resistance increase,which make for the augment of heart backload, while the variation of heart foreload makes the change of the cardiac output. Here is to re-view the influence of pneumopertoneum and postion on hemodynamics changes in gynecological laparoscopic surgery and laparoscopic cholecystectomy.%腹腔镜手术因其独特的优点很快在临床上得到推广,术中因受气腹、体位及麻醉等的影响,血流动力学改变很明显.气腹可导致PaCO2增加(高碳酸血症);腹内压增高,可使肺顺应性降低和导致血流动力学明显改变,后者变化程度依赖于IAP高低和基础血流动力学状态.气腹时平均动脉压增高和周围血管阻力增加,可引起心脏后负荷增加,而心排血量的变化常依赖于前负荷的变化.在此就人工气腹和体位对妇科腹腔镜手术及腹腔镜胆囊切除术中血流动力学的变化进行综述.