FloTrac/Vigileo系统在腹腔镜胆囊切除患者围术期血流动力学监测中的运用

目的 将FloTrac/Vigileo系统用于腹腔镜胆囊切除术患者监测心输出量(CO),观察不同气腹压下血流动力学变化.方法 选择60例择期全麻下行腹腔镜胆囊切除术患者,按照随机数字表法分为三组,每组20例,A组气腹压8 mm Hg,B组气腹压12 mm Hg,C组气腹压15 mm Hg.Philips MP40监护仪监测心率(HR)、心电图(ECG)、血氧饱和度(SpO2),通过FloTrac传感器监测有创动脉血压,Vigileo监护仪接FloTrac传感器连续监测CO.分别记录麻醉诱导前入室静卧10 min后(T0)、气管插管后5 min(T1)、气腹后1 min(T2)、气腹后5 min改变体位时(T3)、气腹后20 min(T4)、气腹结束恢复体位后1 min(T5)、5 min(T6)、术毕拔管后5 min(T7)各时刻的MAP、HR及CO,观察并记录术中术后并发症.结果 与T0、T1时分别比较,各组患者HR、平均动脉压(MAP)在T2～T4时均显著增快和增高,以C组更为明显,差异有统计学意义(P<0.05),A、B两组MAP在T5时基本恢复至T0时水平,而C组至T6时才恢复至T0时水平.B组CO在T2、T3时与T0时相比明显降低,且T2时与A组比较差异有统计学意义(P<0.05),C组CO在T2～T4时与T0时相比显著降低,且T2～T4时与A组比较差异有统计学意义(P<0.05).C组术中出现1例偶发房性早搏,3例显著的心肌缺血改变,术后出现1例室性早搏.结论 气腹压12 mm Hg对腹腔镜胆囊切除术患者围术期血流动力学影响较小,FloTrac/Vigileo系统可以用于持续有效地监测患者血流动力学变化,为更早的临床诊断及决策创造了有利条件,优化围术期麻醉管理.

Applying FloTrac/Vigileo system to monitor hemodynamic changes of laparoscopic cholecystectomy during perioperative period

Objective Applying FloTrac/Vigileo system to monitor the CO value and the change of hemodynamic under different intra-abdominal pressure(IAP)for laparoscopic cholecystectomy(LC).Methods 60 gallbladder removal patients underwent laparoscopes with general anesthesia were selected and randomly divided into three groups(n=20 cases),namely:Group A,IAP 8 mm Hg;Group B,IAP 12 mm Hg;Group C,IAP 15 mm Hg.HR,ECG and SpO2 were monitored by Philips MP40.Invasive arterial blood pressure were measured by FloTrac and CO values were measured by Vigileo.Respectively recording the values of MAP,HR and CO at different time points,burglary repose for 10 minutes before anesthesia(T0),5 minutes after intubation(T1),1 minute after pneumoperitoneum(T2),5 minutes after pneumoperitoneum and patients′ position had been changed(T3),20 minutes after pneumoperitoneum(T4),1 minutes(T5)and 5 minutes(T6)after the end of pneumoperitoneum and recoveried to supine position,5 minutes after extubation when surgery was completed(T7).Results Compared with T0,and T1 seperately,HR,MAP values of T2-T4 increased significantly after pneumoperitoneum.The value of group C was much more obvious and the difference was statistically significant compared with Group A and Group B(P<0.05).MAP values at T5 of Group A and Group B returned to the level of T0,whereas MAP value at T6 of Group C returned to the level of T0.CO value of Group B decreased at T2,T3 compared with T0 and there was significant difference of T2 with Group A(P<0.05).CO value of Group C at T2,T3 and T4 significantly decreased compared with that of T0.CO values of Group C was statistically significant from the value of Group A at T2,T3 and T4(P<0.05).There was 1 case of atrial premature and 3 cases of obvious myocardial ischemia during surgery,and 1 case of ventricular premature on Group C.Conclusions IAP 12 mm Hg has less influences of hemodynamics for patients undergoing laparoscopic cholecystectomy.Applying FloTrac/Vigileo system can effectively and continuously monitor hemodynamic changes,which is favorable for the earlier clinical diagnosis and decision-making.It is convinent to optimize the perioperative anesthetic management with it.