Feldman L S, Anidjar M, Metrakos P, Stanbridge D, Fried G M, Carli F
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, QC, Canada.
Surg Endosc. 2004 Mar;18(3):412-6. doi: 10.1007/s00464-003-8907-1. Epub 2004 Jan 14.
While the popularity of laparoscopic donor nephrectomy (LDN) has increased, concern persists about the potential deleterious effects of pneumoperitoneum on renal function. Thus, preload optimization with vigorous intravenous hydration has been recommended. The purpose of this study was to compare central venous pressure (CVP) monitoring with a noninvasive measure of cardiac preload (esophageal Doppler) during LDN.
Thirteen patients were studied. Following induction of general anesthesia, a Doppler probe was inserted in the lower third of the esophagus to measure flow time corrected for heart rate (FTc), which is an index of preload. In 10 patients, a catheter was placed in the right internal jugular vein and CVP measured. CVP and FTc were measured at baseline in the supine and right lateral decubitus positions, then 15 and 60 min after the establishment of CO(2) pneumoperitoneum (12-15 mmHg). IV fluids were increased if the FTc fell below 300 msec. Results are expressed as means (+/-SD). Data were analyzed using repeated measures ANOVA.
Lateral positioning and pneumoperitoneum significantly increased CVP from baseline ( p < 0.01), while the FTc did not change ( p = 0.57). After 60 min of pneumoperitoneum, the FTc was <300 msec in only one patient.
CVP is not an accurate guide for administration of IV fluids during LDN. Esophageal Doppler monitoring can be used to noninvasively follow changes in preload during LDN and is worthy of further study.
尽管腹腔镜供肾切除术（LDN）的应用越来越广泛，但气腹对肾功能的潜在有害影响仍令人担忧。因此，建议通过积极的静脉补液来优化前负荷。本研究的目的是比较LDN期间中心静脉压（CVP）监测与心脏前负荷的无创测量方法（食管多普勒）。
对13例患者进行研究。全身麻醉诱导后，将多普勒探头插入食管下三分之一处，测量经心率校正的血流时间（FTc），这是前负荷的一个指标。10例患者在右颈内静脉放置导管并测量CVP。在仰卧位和右侧卧位的基线状态下测量CVP和FTc，然后在建立二氧化碳气腹（12 - 15 mmHg）后15分钟和60分钟测量。如果FTc降至300毫秒以下，则增加静脉输液量。结果以均值（±标准差）表示。数据采用重复测量方差分析进行分析。
侧卧位和气腹使CVP较基线显著升高（p < 0.01），而FTc没有变化（p = 0.57）。气腹60分钟后，只有1例患者的FTc < 300毫秒。
CVP不是LDN期间静脉输液的准确指导指标。食管多普勒监测可用于无创跟踪LDN期间前负荷的变化，值得进一步研究。
