El-Dawlatly Abdelazeem Ali
Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Surg Laparosc Endosc Percutan Tech. 2005 Dec;15(6):328-31. doi: 10.1097/01.sle.0000191591.93326.b8.
Endoscopic thoracic sympathectomy (ETS) is a minimally invasive procedure for treating palmar hyperhidrosis (PH). Hemodynamic changes are associated with CO(2) insufflation during ETS. In the present study, we examined hemodynamic changes during general anesthesia using impedance cardiography (ICG) monitor. Seventeen adult patients (15 males) scheduled to undergo elective unilateral ETS for treatment of PH were enrolled in the study. Patients with cardiorespiratory diseases were excluded from the study. Their age and weight mean values were 26.5 +/- 5 years, 71.9 +/- 11.5 kg, respectively. Besides routine monitoring, impedance cardiography monitor was used to measure cardiac output (CO), cardiac index (CI), stroke volume (SV), thoracic fluid content (TFC), and systemic vascular resistance (SVR). Three phases were defined for data collection: A, prior to CO(2) insufflation; B during gas insufflation (at 10, 5, and 2 mm Hg intrathoracic pressures); and C, after gas deflation. Repeated-measures analysis of variance (ANOVA) was used for statistical analysis and post hoc Bonferroni test for multiple comparisons of the data obtained. For all comparisons, P < 0.05 was considered significant. Systemic vascular resistance significantly increased at stages B10 and 5 compared with stage A mean value (P < 0.05). CO, CI, and SV mean values decreased significantly at stage B compared with stage A mean values. The mean values of thoracic fluid content at stages A, B10, 5, 2, and C were 33 +/- 5, 30.6 +/- 3.5, 31 +/- 3.4, 31.6 +/- 3.3, and 32.5 +/- 6.8/kOmega, respectively with significant differences (P < 0.05). Significant reductions of cardiac parameters were reported in the present study, but they were of minimal clinical significance. Of interest was the significant reduction of thoracic fluid content during CO(2) insufflation, whether it correlates to the magnitude of compression, caused by CO(2) insufflation accompanied by high systemic vascular resistance or sympathectomy procedure, yet to be further studied.
内镜下胸交感神经切除术（ETS）是一种治疗手掌多汗症（PH）的微创手术。血流动力学变化与ETS术中二氧化碳气腹有关。在本研究中，我们使用阻抗心动图（ICG）监测仪检查全身麻醉期间的血流动力学变化。17例计划接受择期单侧ETS治疗PH的成年患者（15例男性）纳入本研究。患有心肺疾病的患者被排除在研究之外。他们的年龄和体重平均值分别为26.5±5岁、71.9±11.5千克。除常规监测外，使用阻抗心动图监测仪测量心输出量（CO）、心脏指数（CI）、每搏输出量（SV）、胸液含量（TFC）和全身血管阻力（SVR）。定义了三个数据收集阶段：A，二氧化碳气腹前；B，气腹期间（胸内压为10、5和2毫米汞柱时）；C，放气后。采用重复测量方差分析（ANOVA）进行统计分析，并采用事后Bonferroni检验对所得数据进行多重比较。所有比较中，P<0.05被认为具有统计学意义。与阶段A平均值相比，阶段B10和5时全身血管阻力显著增加（P<0.05）。与阶段A平均值相比，阶段B时CO、CI和SV平均值显著降低。阶段A、B10、5、2和C时胸液含量的平均值分别为33±5、30.6±3.5、31±3.4、31.6±3.3和32.5±6.8/kΩ，差异有统计学意义（P<0.05）。本研究报告了心脏参数的显著降低，但它们的临床意义极小。有趣的是，二氧化碳气腹期间胸液含量显著降低，其是否与二氧化碳气腹伴随高全身血管阻力或交感神经切除术引起的压迫程度相关，尚待进一步研究。
