腹腔镜手术对高血压Ⅱ级患者血流动力学的影响

摘要

目的探讨妇科腹腔镜手术中CO2气腹和头低脚高位（Trendelenburg体位）对高血压Ⅱ级患者血流动力学及肾脏功能的影响。方法30例腹腔镜全子宫切除术病例，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级Ⅰ～Ⅲ级，分为两组，H组（n=15）：高血压组（血压160～179mmHg/100～109mmHg），C组（n=15）：无高血压病对照组。观察麻醉诱导前（T0）、麻醉诱导后（T1）、气腹后平卧位（T2）、气腹后头低脚高10°位（T3）、气腹后头低脚高20°位（T4）、恢复头低脚高10°位10分钟（T5）、30分钟（T6）、60分钟（T7）、气腹解除（T8）时的收缩压、舒张压、平均动脉压、心率、心输出量、心脏指数、每搏输出量、每搏指数、每搏变异度、外周血管阻力、外周血管阻力指数、中心静脉压和呼气末二氧化碳分压，以及术前、术中1小时、术后1小时、术后3小时血清肌酐、尿素氮、β2-微球蛋白。结果 T2点H组收缩压、外周血管阻力、外周血管阻力指数、中心静脉压明显高于C组（P＜0.05）；与T2比较，T4两组收缩压、舒张压、平均动脉压、中心静脉压均升高（P＜0.05），T3各指标差异无显著性（P＞0.05），两组间差异无显著性（P＞0.05）；气腹后H组心输出量、心脏指数、每搏输出量、每搏指数升高与C组比较差异无显著性（P＞0.05）；气腹后H组肌酐、尿素氮、β2-微球蛋白与C组比较差异无显著性（P＞0.05）。结论气腹会导致高血压Ⅱ级患者收缩压增高，但血流动力学变化尚在可接受范围内，并未加重肾脏负担，采取Trendelenburg体位10°位比20°位循环更稳定。%Objective The purpose of this study is to evaluate the hemodynamics and renal function change associated with carbon dioxide (CO2) pneumoperitoneum and Trendelenburg position in the patient with hypertension stageⅡ.Method 30 ASAⅠ toⅢ Patients, undergoing laparoscopic hysterectomy were enrolled in this study. The patients were divided into 2 groups: hypertension stageⅡ group (group H, 160~179mmHg/100~109mmHg,n=15), normal blood pressure (group C,n=15). SBP, DBP, MAP, HR, CO, CI, SV, SVI, SVV, SVR, SVRI, CVP and ETCO2 were assessed before anesthesia induction(T0), supine position after anesthesia induction(T1), supine position after pneumoperitoneum insu-fflation(T2), Trendelenburg position 10°after pneumoperitoneum insufflation(T3), Trendelenburg position 20°(T4), 10min(T5), 30min(T6), 60min(T7) after pneumo-peritoneum insufflation and 5 min after deflation(T8). Cr, BUN, andβ2-MG was examined on preoperation, 1h intraoPerative, 1h and 3h postoperative.ResultAfter pneumoperitoneum insufflation, SBP, SVR, SVRI and CVP increased significantly in group H than in group C(P<0.05). SBP, DBP, MAP, SVR and SVRI in both group increased after pneumoperitoneum (P<0.05). Placing the patient in the Trendelenburg position 20°caused a significant increase in SBP, DBP, MAP and CVP (P<0.05), whereas hemodynamic parameters remained nearly unaffected in the Trendelenburg position 10°. CO, CI, SV and SVI remained unchanged, and did not demonstrate significant differences among the two groups (P>0.05). Cr, BUN andβ2-MG remained unchanged, and did not demonstrate significant differences among the two groups(P>0.05).ConclusionInsufflation of pneumoperitoneum does not cause significant alterations in homodynamic and renal function changes in the patients with hypertension.The patients with hypertension stageⅡ can underwent laparoscopic surgery more stability.