胸腔镜下交感神经切除对血流动力学的影响

目的观察电视胸腔镜(video assisted thoracoscopic surgery，VATS)下胸交感神经切除术(transthoracic endoscopic sympathectomy，TES)时CO2人工气胸及手术操作对血流动力学的影响。方法对35例手汗症患者在气管插管全身麻醉情况下行胸腔镜下双侧胸交感神经切除。术中给予3～5cmH2O的CO2胸腔正压。观察记录患者麻醉前、诱导后、手术开始时、先后两侧胸交感神经切除时、胸交感神经切断后5min、10min心率(HR)、收缩压(SBP)、舒张压(DBP)、平均压(MAP)、中心静脉压(Cvp)、经皮氧饱和度(SpO2)变化。结果与麻醉前及手术开始时相比，术中HR明显减慢；与麻醉前相比，诱导后SBP、DBP、MAP明显下降，手术开始及以后各时点SBP、DBP、MAP平稳；CVP和SpO2平稳。结论在行胸腔镜下交感神经切除时。特别是在交感神经切断后能引起心率减慢。在3～5cmH2的CO2胸腔正压下行TES能在保证手术视野和操作的情况下将SBP、DBP、MAP、SpO2维持在正常范围。

Influences of transthoracic endoscopic sympathectomy on hemodynamics

Objective] To observe the influences of transthoracic endoscopic sympathectomy (TES) with artificial carbon dioxide pneumothorax and procedures on hemodynamics. [Methods] 35 patients with palmar hyperhidrosis underwent transthoracic endoscopic sympathectomy (TES) with endotracheal aneasthesia and 3~5 cmH2O carbon dioxide thoracic postitive pressure during operation. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressures (MBP), central venous pressure (CVP), pulse oxygen saturation (SpO2) were recorded before aneasthesia, after induction, operation beginning, sequence bilateral sympathectomy, 5 min, 10 min after sympathectomy. [Results] HR during operation significantly lower than that before aneasthesia and of operation beginning. Compared with before aneasthesia, SBP, DBP and MBP after induction significantly lower, and those of other times had no significant change. CVP after induction significantly change. [Conclusions] TES especially after sympathectomy can slow HR. TES with 3~5 cmH2O carbon dioxide thoracic positive pressure, ensureing good operation view, can maintain SBP, DBP and MBP CVP SpO2 in normal range.