[1]李岩,王春艺,李刚,等.腹腔镜结直肠癌根治术气腹及Trendelenburg体位对≥60岁患者脑血流的影响[J].中国微创外科杂志,2017,17(07):585-588.
　Li Yan,Wang Chunyi,Li Gang,et al.Effect of Carbon Dioxide Pneumoperitoneum and Trendelenburg Position on the Cerebral Artery Blood Flow During Laparoscopic Surgery in Patients Over 60 Years Old[J].Chinese Journal of Minimally Invasive Surgery,2017,17(07):585-588.
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腹腔镜结直肠癌根治术气腹及Trendelenburg体位对≥60岁患者脑血流的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年07期
页码:
585-588
栏目:
临床论著
出版日期:
2017-07-20

文章信息/Info

Title:
Effect of Carbon Dioxide Pneumoperitoneum and Trendelenburg Position on the Cerebral Artery Blood Flow During Laparoscopic Surgery in Patients Over 60 Years Old
作者:
李岩; 王春艺; 李刚; 郭向阳**
北京大学第三医院麻醉科，北京100083
Author(s):
Li Yan;  Wang Chunyi;  Li Gang;  et al.
Department of Anesthesiology, Peking University Third Hospital, Beijing 100083, China
关键词:
老年患者; 气腹; 头低脚高位; 脑动脉血流
Keywords:
Elderly patients; Pneumoperitoneum; Trendelenburg position; Cerebral blood flow
文献标志码:
A
摘要:
目的探讨气腹及Trendelenburg体位对腹腔镜结直肠癌根治术≥60岁患者脑动脉血流的影响。 方法2014年6月~2015年9月100例限期腹腔镜结直肠癌根治术≥60岁患者， ASAⅠ～Ⅱ级，手术时间>2 h，按照年龄分为2组，每组50例：60～70岁为A组，70岁以上为B组。应用经颅多普勒技术监测右侧大脑中动脉血流信号，分别于麻醉诱导前（T0）、气管插管后5 min（T1）、气腹完成后（T2）、调节头低脚高30°体位即刻（T3），调节体位后1 h（T4），调节体位后2 h（T5）以及停气腹恢复平卧位10 min（T6）记录收缩期峰流速（Vs）、平均流速（Vm）和搏动指数（PI），并同时记录患者各时间点平均动脉压（MAP）。 结果A组患者Vs在T4~T6时点分别为(73.1±10.8)、（73.5±9.9）、（77.5±10.9）cm/s，较T1 时点（66.4±93）cm/s 显著升高（P<0.05）；Vm在T3~T6时点分别为（55.3±7.9）、（54.5±9.2）、（57.3±10.1）、（68.9±9.9）cm/s，较T1时点（48.3±8.1）cm/s显著升高（P<0.05）。B组Vs在T3～T6分别为（74.4±9.5）、（78.2±9.5）、（79.0±10.3）、（82.0±9.3）cm/s，均较T1时点（65.8±8.9）cm/s显著增高（P<0.05）；Vm在T2～T6分别为（55.2±7.6）、（59.3±9.5）、（59.2±8.7）、（61.6±10.2）、（67.6±8.8）cm/s均较T1时点（46.5±8.9）cm/s显著增高（P<0.05）。B组在T2～T5时点Vs和Vm均显著高于A组（P<0.05），在T3～T6时点PI显著高于A组（P<0.05）。2组间各时点MAP无明显差异（P>0.05）。 结论腹腔镜结直肠癌根治术中Trendelenburg 30° 体位使老年患者脑动脉血流增加，≥70岁患者较60~70岁患者脑血流受气腹及体位的影响更加明显。
Abstract:
ObjectiveTo evaluate the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on the cerebral artery blood flow during laparoscopic surgery in patients over 60 years old. MethodsOne hundred elderly patients, ASA physical status Ⅰ-Ⅱ, aged ≥60 years, with operating time > 2 h of elective laparoscopic surgery, were assigned into two groups according to patient’s age (n=50 each): patients aged 60-70 years were enrolled in group A and patients aged 70 years or older in group B. For all the patients, blood flow signals of right middle cerebral artery were detected by transcranial Doppler and systolic blood flow velocity (Vs), mean blood flow velocity (Vm), and pulsatility index (PI) were recorded at baseline before anesthesia induction (T0), 5 min after endotracheal intubation (T1), after pneumoperitoneum achieved (T2), immediately, 1 h, and 2 h after Trendelenberg position (T3, T4, and T5, respectively), and 10 min in supine position after termination of pneumoperitoneum (T6). The mean arterial pressure (MAP) was also recorded at each time-point. ResultsIn group A, the values of Vs from T4 to T6 were (73.1±10.8), (73.5±9.9), (77.5±109) cm/s, respectively, which were much faster than that at T1 (66.4±9.3) cm/s (P<0.05). Similarly, the values of Vm from T3 to T6 were (55.3±7.9), (54.5±9.2), (57.3±10.1), (68.9±9.9) cm/s, respectively, which were much faster than that at T1 (48.3±8.1) cm/s (P<0.05). In group B, the values of Vs from T3 to T6 were (74.4±95), (78.2±9.5), (79.0±10.3), and (82.0±9.3) cm/s, respectively, all of which were much faster than that at T1 (65.8±8.9) cm/s (P<0.05). Similarly, the values of Vm from T2 to T6 were (55.2±7.6), (59.3±9.5), (59.2±87), (61.6±102), and (67.6±8.8) cm/s, respectively, all of which were much faster than that at T1 (46.5±8.9) cm/s (P<0.05). The values of Vs, Vm at T2-T5 were much faster in group B than those in group A (P<0.05). While the values of PI at T3-T6 were much faster in group B than those in group A (P<0.05). There was no significant difference in MAP between the two groups (P>005).ConclusionsTrendelenburg position at 30° cause increased cerebral blood backflow in elderly patients during laparoscopic surgery. With the increase of age, the impact of pneumoperitoneum and Trendelenburg position on cerebral blood flow is more obvious.

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备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项基金资助(项目编号：首发2011-4023414)**通讯作者，E-mail：puthmzk@163.com
更新日期/Last Update: 2017-09-21