间歇充气加压对腹腔镜胃癌手术下肢深静脉血流动力学的影响

目的观察间歇充气加压对腹腔镜胃癌手术患者下肢深静脉血流动力学的影响,并探讨其可能机制。方法将腹腔镜胃癌手术患者随机分成使用间歇充气加压组(实验组)和不使用间歇充气加压组(对照组),通过彩色多普勒方法测定手术过程中不同时间点股静脉直径、血流速度及血流量。结果与气腹前平卧位相比,两组气腹形成后取头高脚低位患者股静脉直径均增大,平均血流速度及血流量均降低(P<0.01);术中,随着手术时间的延长,股静脉直径无明显变化,但平均血流速度及血流量均显著减少(P<0.05);至术毕CO2气体排出后、麻醉恢复前取平卧位时股静脉直径变细(P<0.01),平均血流速度及血流量均增加(P<0.01),但仍达不到气腹前平卧位水平(P<0.05)。实验组手术过程中,股静脉、平均血流速度及血流量均维持在较稳定状态。两组间各时间点血流动力学指标差异有统计学意义(P<0.05,P<0.01)。结论间歇充气加压可有效改善腹腔镜胃癌手术操作(CO2气腹建立、头高脚低位及手术时间延长)所致的股静脉血流动力学变化(管径变粗、血流速度减慢、血流量减少),降低术后下肢深静脉血栓发生的风险。

Effect of intermittent pneumatic compression on lower limb deep venous hemodynamics in patients receiving surgery for gastric cancer under laparoscope

Objective To observe intermittent pneumatic compression in patients with laparoscopic gastric surgery for lower limb deep venous hemodynamics, and to explore the mechanism. Methods The laparoscopic gastric cancer surgery were randomly divided into the control group and experimental group. And the femoral vein diameter (R), blood flow velocity (V) and blood flow (Q) were determined by color Doppler at different time points during the operation. Results Compared with supine position before pneumoperitoneum, the femoral vein diameter in control group which maintained the first high-pin low position during pneumoperitoneum increased significantly,and the average blood flow velocity and blood flow were both significantly lower (P <0.01); in surgery, with the operation time extension, although the femoral vein diameter had no obvious change (P> 0.05), but the average flow velocity and blood flow were both significantly reduced (P <0.05); After surgery and CO2 gas emission, before postanesthetic revival, which in supine position, femoral vein diameter was thinner (P <0.01), mean flow velocity and blood flow were both significantly increased (P <0.01), but still not reach the level of supine position before pneumoperitoneum (P <0.05). During surgery the experimental group, the femoral vein, the average flow velocity and blood flow were all maintained at a stable state. There were much difference of two groups at each time point hemodynamics. Conclusion Intermittent pneumatic compression is effective in improving, in laparoscopic gastric cancer surgery, the establishment of particular CO2 pneumoperitoneum, and the first high-foot low positon, and prolonged operative time due to femoral vein diameter and thicker, slower blood flow, blood flow decreased reduce postoperative deep vein thrombosis risk.