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目的探讨妇科腹腔镜手术中采用FloTrac/Vigileo系统监测下的CO_2气腹压力(IAP)对患者血流动力学的影响。方法选择拟行妇科腹腔镜手术的子宫肌瘤、卵巢囊肿患者66例,采用随机数字表法将其分为IAP10mmHg组、12mm Hg组和15mm Hg组,每组22例,采用FloTrac/Vigileo系统检测患者的血流动力学,并记录各监测指标的变化。结果三组患者麻醉后5min(T0)的心率、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)和每博输出量(SV)比较,差异均无统计学意义(P>0.05);三组气腹后1 min(T1)、气腹后5min(T2)、气腹后15 min(T3)患者的心率、MAP、CO与T0组比较,差异有统计学意义(P<0.05);15mm Hg组在T1、T2、T3的心率、MAP、CO波动较10 mm Hg组和12 mm Hg组患者显著(P<0.05)。15mm Hg组患者心律失常、呕吐等并发症发生率为31.82%(7/22),与10mm Hg组和12mm Hg组的4.55%(1/22)比较,差异有统计学意义(P<0.05)。结论妇科腹腔镜手术中不同CO_2气腹压力患者的血流动力学出现一定的波动,但是其压力在10mm Hg和12mm Hg波动范围较小,且手术并发症较低。
Objective To investigate the effect of CO_2 pneumoperitoneum pressure (IAP) monitored by FloTrac / Vigileo system in gynecological laparoscopic surgery on hemodynamics. Methods Sixty-six patients with uterine fibroids and ovarian cysts who underwent gynecological laparoscopic surgery were divided into IAP10mmHg group, 12mm Hg group and 15mm Hg group by random number table. Each group was treated with FloTrac / Vigileo system Patient’s hemodynamics, and record changes in the monitoring indicators. Results There was no significant difference in heart rate, mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI) and per-sperm output (SV) at 5 min after anesthesia in three groups > 0.05). There were significant differences in heart rate, MAP, CO and T0 among three groups after 1 min (T1), 5 min after pneumoperitoneum (T2) and 15 min after pneumoperitoneum (P <0.05). The heart rate, MAP and CO of 15 mm Hg group were significantly higher than those of 10 mm Hg group and 12 mm Hg group at T1, T2 and T3 (P <0.05). The incidence of complications such as arrhythmia and vomiting in 15mm Hg group was 31.82% (7/22), which was significantly different from 4.55% (1/22) in 10mm Hg group and 12mm Hg group (P <0.05) . Conclusions The hemodynamics of patients with different CO_2 pneumoperitoneum pressure during gynecological laparoscopic surgery showed some fluctuations, but the pressure was less fluctuated at 10mm Hg and 12mm Hg, and the complications were lower.