[1]张新建,王晖玥,叶丽妮.宫腹腔镜联合手术中患者体位对血流动力学与局部脑组织氧饱和度的影响[J].新乡医学院学报,2020,37(7):657-660.[doi:10.7683/xxyxyxb.2020.07.014]
　ZHANG Xinjian,WANG Huiyue,YE Lini.Effect of body position on the hemodynamics and regional cerebral oxygen saturation in patients undergoing hysteroscopic-laparoscopic operation[J].Journal of Xinxiang Medical University,2020,37(7):657-660.[doi:10.7683/xxyxyxb.2020.07.014]
点击复制

宫腹腔镜联合手术中患者体位对血流动力学与局部脑组织氧饱和度的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年7
页码:
657-660
栏目:
临床研究
出版日期:
2020-07-05

文章信息/Info

Title:
Effect of body position on the hemodynamics and regional cerebral oxygen saturation in patients undergoing hysteroscopic-laparoscopic operation
作者:
张新建; 王晖玥; 叶丽妮
（广州中医药大学第三附属医院麻醉科，广东　广州　510378）
Author(s):
ZHANG Xinjian; WANG Huiyue; YE Lini
(Department of Anesthesiology,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong Province,China)
关键词:
宫腹腔镜联合手术; 局部脑组织氧饱和度; 血流动力学; 头低位; 截石位
Keywords:
hysteroscopic-laparoscopic operation; regional cerebral oxygen saturation; hemodynamics; head-low position; lithotomy position
分类号:
R614.2
DOI:
10.7683/xxyxyxb.2020.07.014
文献标志码:
A
摘要:
目的　探讨不同角度的头低臀高截石位对静脉-吸入复合麻醉下宫腹腔镜联合手术患者血流动力学和局部脑组织氧饱和度（rSCO2）的影响。方法　选择2018年9月至2019年9月广州中医药大学第三附属医院收治的120例女性不孕症患者为研究对象，所有患者在静脉-吸入复合麻醉下行宫腹腔镜联合手术，患者术中体位为头低臀高截石位，根据术中头低角度将患者分为15°组、25°组和35°组，每组40例。观察3组患者麻醉诱导前（T0）、喉罩置入后5 min（T1）、建立气腹前（T2）、建立气腹后5 min（T3）、头低臀高截石位5 min（T4）、头低臀高截石位30 min（T5）、气腹结束后平卧位5 min（T6）、麻醉清醒拔出喉罩后5 min（T7）的心率（HR）、平均动脉压（MAP）和rSCO2；并记录3组患者手术时间、术中出血量、术中尿量及术中输液量。结果　3组患者T0、T1、T2、T6、T7时HR比较差异无统计学意义（P>0.05），3组患者T3、T4、T5时HR低于T0时（P<0.05）。3组患者T1、T2时MAP低于T0时，T3、T4、T5时MAP高于T0时（P<0.05）；3组患者T0、T6、T7时MAP比较差异无统计学意义（P>0.05）。3组患者T4、T5时rSCO2高于T0时（P<0.05），3组患者T0、T1、T2、T3、T6、T7时rSCO2比较差异无统计学意义（P>0.05）。T0、T1、T2、T3、T4、T5、T6、T7时3组患者HR比较差异均无统计学意义（P>0.05）； T0、T1、T2、T3、T6、T7时3组患者MAP、rSCO2比较差异均无统计学意义（P>0.05）；T4、T5时，25°组和35°组患者MAP高于15°组（P<0.05），35°组患者rSCO2高于15°组（P<0.05），35°组与25°组患者rSCO2比较差异无统计学意义（P>0.05），25°组与15°组患者rSCO2比较差异无统计学意义（P>0.05）。结论　对于静脉-吸入复合麻醉下行宫腹腔镜联合手术的年轻女性不孕症患者，头低臀高截石位对MAP和rSCO2影响较大，且头低角度（≤35°）越大影响越明显，但血流动力学和rSCO2监测值均在正常范围内。
Abstract:
Objective　To investigate the effect of different angled lithotomy position with low head and high hip on the hemodynamics and regional cerebral oxygen saturation (rSCO2) in patients undergoing hysteroscopic-laparoscopic operation under combined intravenous and inhalation anesthesia.Methods　A total of 120 female infertility patients admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2018 to September 2019 were selected as the study objects.All patients underwent hysteroscopic-laparoscopic operation under combined intravenous and inhalation anesthesia.The body position of the patients was lithotomy position with low head and high hip during the operation,and the patients were divided into 15° group,25° group and 35° group according to the angle of head,with 40 cases in each group.The heart rate (HR),mean arterial pressure (MAP) and rSCO2 were observed at the time points of before anesthesia induction (T0),5 minutes after laryngeal mask implantation (T1),before the establishment of pneumoperitoneum (T2),5 minutes after the establishment of pneumoperitoneum (T3),5 minutes in lithotomy position with low head and high hip (T4),30 minutes in lithotomy position with low head and high hip (T5),5 minutes in supine position after pneumoperitoneum (T6) and 5 minutes after pulling out laryngeal mask (T7).The operation time,intraoperative bleeding volume,intraoperative urine volume and intraoperative transfusion volume were recorded.Results　There was no significant difference in the HR at T0,T1,T2,T6 and T7 in the three groups (P>0.05).The HR of patients in the three groups at T3,T4 and T5 was lower than that at T0 (P<0.05).The MAP of patients in the three groups at T1 and T2 was lower than that at T0,and the MAP of patients at T3,T4 and T5 was higher than that at T0 (P<0.05).There was no significant difference in the MAP among the three groups at T0,T6 and T7 (P>0.05).The rSCO2 at T4 and T5 was higher than that at T0 in the three groups (P<0.05).There was no significant difference in the rSCO2 at T0,T1,T2,T3,T6 and T7 in the three groups (P>0.05).There was no significant difference in the HR among the three groups at T0,T1,T2,T3,T4,T5,T6 and T7 (P>0.05).There was no significant difference in the MAP and rSCO2 among the three groups at T0,T1,T2,T3,T6 and T7 (P>0.05).At T4 and T5,the MAP of patients in the 25° group and 35° group was higher than that in the 15° group(P<0.05),the rSCO2 of patients in the 35° group was higher than that in the 15° group(P<0.05),but there was no significant difference in the rSCO2 between the 35° group and 25° group(P>0.05),and there was no significant difference in the rSCO2 between the 25° group and 15° group(P>0.05).Conclusion　For the young female infertility patients undergoing hysteroscopic-laparoscopic operation under combined intravenous and inhalation anesthesia,the lithotomy position with low head and high hip has a greater impact on the MAP and rSCO2,and with the increase of the angle of head (≤35°),the influence is more obvious,but the hemodynamics and rSCO2 are within the normal range.

参考文献/References:

［1］　ABDALMAGEED O S,BEDAIWY M A,FALCONE T.Nerve injuries in gynecologic laparoscopy［J］.J Minim Invasive Gynecol,2017,24(1):16-27.
［2］　MURPHY G S,GREENBERG S B,SZOKOL J W.Safety of beach chair position shoulder surgery:a review of the current literature［J］.Anesth Analg,2019,129(1):101-118.
［3］　PALMAERS T.Anesthesia and hemodynamic management in the sitting position［J］.Anasthesiol Intensivmed Notfallmed Schmerzther,2015,50(4):280-286.
［4］　KURUKAHVECIOGLU O,SARE M,KARAMERCAN A,et al.Intermittent pneumatic sequential compression of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy［J］.Surg Endosc,2016,22(4):907-911.
［5］　常昕，郭震，施丹，等.体外循环心脏手术中脑组织氧饱和度最低值与术后认知功能障碍相关性分析［J］.中国体外循环杂志，2019，17（1）：26-31.
［6］　BRINJIKJI W,PASTERNAK J,MURAD M H,et al.Anesthesia-related outcomes for endovascular stroke revascularization:a systematic review and meta-analysis［J］.Stroke,2017,48(10):2784-2791.
［7］　KOBAYASHUI K,KITAMURA T,KOHIRA S,et al.Cerebral oximetry for cardiac surgery:a preoperative comparison of device characteristics and pitfalls in interpretation［J］.J Artif Organs,2018,21(4):412-418.
［8］　KISHI K,KAWAGUCHI M,YOSHITANI K,et al.Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers［J］.J Neurosurg Anesthesiol,2003,15(4):302-306.
［9］　ATKINSON T M,GIRAUD G D,TOGIKA B M,et al.Cardiovascular and ventilatory consequences of laparoscopic surgery［J］.Circulation,2017,135(7):700-710.
［10］　PARK S,YOOK K,YOO K Y,et al.Comparison of the effect of sevoflurane or propofol anesthesia on the regional cerebral oxygen saturation in patients undergoing carotid endarterectomy:a prospective,randomized controlled study［J］.BMC Anesthesiol,2019,19(1):157.
［11］　RADAK D,SOTIROVIC V,OBRADOVIC M,et al.Practial use of near-infrared spectroscopy in carotid surgery［J］.Angiology,2014,65(9):769-772.
［12］　王辉，秦再生，徐建设，等.二氧化碳气腹及头低位对老年患者脑氧供需平衡和能量代谢的影响［J］.新乡医学院学报，2011，28（6）：746-748.
［13］　侯景利，徐世元，许平，等.异丙酚-芬太尼麻醉下妇科腹腔镜手术患者脑葡萄糖与氧代谢的变化［J］.中华麻醉学杂志，2005，25（11）：811-813.
［14］　SCHRAMM P,TZANOVA I,HGEN F,et al.Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures:a prospective observational study［J］.Br J Anaesth,2016,117(4):482-488.
［15］　MENG L,GRUENBAUM S E,DAI F,et al.Physiology,intervention,and outcome:three critical questions about cerebral tissue oxygen saturation monitoring［J］.Minerva Anestesiol,2018,84 (5):599-614.
［16］　RUZMAN T,MRAOVIC B,SIMURINA T,et al.Transcranial cerebral cxymetric conitoring reduces brain hypoxia in obese and elderly patients undergoing general anesthesia for laparoscopic cholecystectomy［J］.Surg Laparosc Endosc Percutan Tech,2017,27(4):248-252.
［17］　EYEINGTON C T,ANCONA P,OSAWA E A,et al.Modern technology-derived normative values for cerebral tissue oxygen saturation in adults［J］.Anaesth Intensive Care,2019,147(1):69-75.
［18］　VRANKEN N P A,WEERWIND P W,SUTEDJA N A,et al.Cerebral oximetry and autoregulation during cardiopulmonary bypass:a review［J］.J Extra Corpor Technol,2017,49(3):182-191.

更新日期/Last Update: 2020-07-05