Meininger Dirk, Zwissler Bernhard, Byhahn Christian, Probst Michael, Westphal Klaus, Bremerich Dorothee H
Department of Anesthesiology, Intensive Care Medicine and Pain Control, J. W. Goethe-University Hospital, Theodor-Stern-Kai 7, Frankfurt, D-60590 Germany.
World J Surg. 2006 Apr;30(4):520-6. doi: 10.1007/s00268-005-0133-7.
Anesthesia adversely affects respiratory function and hemodynamics in obese patients. Although many studies have been performed in morbidly obese patients, data are limited concerning overweight patients [BMI 25-29.9 kg m(-2)]. The aim of this study was to evaluate the effects of prolonged pneumoperitoneum in Trendelenburg position on hemodynamics and gas exchange in normal and overweight patients.
We studied 15 overweight and 15 non-obese [BMI 18.5-24.9 kg m(-2)] patients who underwent totally endoscopic robot-assisted radical prostatectomy under general anesthesia with an inspired oxygen fraction of 0.5. A standardized anesthetic regimen was used, and patients were examined at standard times: after induction of anesthesia and Trendelenburg posture, every 30 minutes after establishing pneumoperitoneum, and after the release of the pneumoperitoneum with the patient still in Trendelenburg position.
After induction of anesthesia and Trendelenburg positioning arterial oxygen pressure [P(a)O2] and alveolar-arterial difference in oxygen tension [A(a)DO2] differed significantly between both groups with lower P(a)O2 [235 +/- 27 versus 164 +/- 51 mmHg] and higher A(a)DO2 [149 +/- 48 versus 76 +/- 28 mmHg] values in overweight patients. During pneumoperitoneum, P(a)O2 transient increased above baseline values in overweight patients, whereas A(a)DO2 decreased. Hemodynamic parameters [HR, MAP, and CVP] did not differ significantly between groups.
Arterial oxygenation and A(a)DO2 are significantly impaired in overweight patients under general anesthesia in Trendelenburg posture. In overweight patients pneumoperitoneum transient reduced the impairment of arterial oxygenation and lead to a decrease in A(a)DO2. Hemodynamic parameters were not affected by body weight.
麻醉对肥胖患者的呼吸功能和血流动力学有不利影响。尽管已对病态肥胖患者进行了许多研究，但关于超重患者[体重指数（BMI）25 - 29.9 kg/m²]的数据有限。本研究的目的是评估在头低脚高位下长时间气腹对正常体重和超重患者血流动力学及气体交换的影响。
我们研究了15例超重患者和15例非肥胖患者[BMI 18.5 - 24.9 kg/m²]，这些患者在吸入氧分数为0.5的全身麻醉下接受完全内镜机器人辅助根治性前列腺切除术。采用标准化麻醉方案，并在标准时间对患者进行检查：麻醉诱导和头低脚高位后、气腹建立后每30分钟、气腹解除后患者仍处于头低脚高位时。
麻醉诱导和头低脚高位定位后，两组间动脉血氧分压[P(a)O₂]和肺泡 - 动脉氧分压差[A(a)DO₂]存在显著差异，超重患者的P(a)O₂较低[235 ± 27 vs 164 ± 51 mmHg]，A(a)DO₂较高[149 ± 48 vs 76 ± 28 mmHg]。气腹期间，超重患者的P(a)O₂短暂升高超过基线值，而A(a)DO₂降低。血流动力学参数[心率（HR）、平均动脉压（MAP）和中心静脉压（CVP）]在两组间无显著差异。
在头低脚高位全身麻醉下，超重患者的动脉氧合和A(a)DO₂显著受损。在超重患者中，气腹短暂减轻了动脉氧合损害并导致A(a)DO₂降低。血流动力学参数不受体重影响。
