通过压力记录分析法对超级肥胖患者进行腹腔镜胃旁路手术期间的连续血流动力学监测。

Continuous hemodynamic monitoring during laparoscopic gastric bypass in superobese patients by pressure recording analytical method.

作者信息

Balderi Tania, Forfori Francesco, Marra Valeria, Di Salvo Claudio, Dorigo Massimo, Anselmino Marco, Romano Salvatore Mario, Giunta Francesco

机构信息

Division of Anesthesiology and Intensive Care, Department of Surgery, University of Pisa, Pisa, Italy.

出版信息

Obes Surg. 2008 Aug;18(8):1007-14. doi: 10.1007/s11695-007-9379-5. Epub 2008 Apr 15.

DOI:10.1007/s11695-007-9379-5

PMID:18414959

Abstract

BACKGROUND

Morbid obesity, compromising cardiovascular and respiratory function, may increase the risk of anesthesia and was initially considered a contraindication to laparoscopy. The aim of this study was to investigate hemodynamic effects induced by pneumoperitoneum in superobese patients, assessed by arterial pulse contour method.

METHODS

We prospectively studied 10 obese patients (BMI 53 +/- 9 kg/m(2)), scheduled for laparoscopic gastric bypass. After anesthesia induction, patients were intubated and mechanically ventilated. A radial artery was cannulated to obtain hemodynamic data implemented by means of a new pulse contour analysis method-the pressure recording analytical method (PRAM). Data were recorded after anesthesia induction (Tbas), at peritoneal insufflation (T0), at 1, 3, 5, 10, 30, and 60 min after pneumoperitoneum induction (T1, T3, T5, T10, T15, T30, T60), at abdominal desufflation (Tdef) and 5 min after desufflation (T5def).

RESULTS

MAP increased after pneumoperitoneum, returning to its baseline after deflation (79 +/- 7 Tbas, 81 +/- 6 mmHg T5def). HR remained unchanged. Systemic vascular resistance index (SVRI) increased after pneumoperitoneum induction and progressively returned to baseline (3,903 +/- 330 Tbas, 4,596 +/- 148 T1, and 3,786 +/- 202 dyn s m(2) cm(-5) T5def). Stroke volume index (SVI) and cardiac index (CI) increased after pneumoperitoneum and remained elevated. Stroke volume variation (SVV) decreased after insufflation remaining lower than the basal value (28 +/- 4% Tbas, 15 +/- 5% T5des). Cardiac Cycle Efficiency (CCE) transient decreased after insufflation and subsequently increased (0.029 +/- 0.146 Tbas, 0.008 +/- 0.178 T5def). Aortic dP/dt max increased after insufflation, returning to baseline only after desufflation (0.68 +/- 0.07 Tbas, 0.94 +/- 0.08 T30 and 0.86 +/- 0.06 mmHg s(-1) T5def).

CONCLUSION

As assessed by PRAM, this study showed no deterioration in hemodynamic indices or ventricular performance during laparoscopic gastric bypass.

摘要

背景

病态肥胖会损害心血管和呼吸功能，可能增加麻醉风险，最初被视为腹腔镜检查的禁忌证。本研究旨在通过动脉脉搏轮廓法研究超肥胖患者气腹引起的血流动力学效应。

方法

我们前瞻性研究了10例计划行腹腔镜胃旁路手术的肥胖患者（BMI 53±9 kg/m²）。麻醉诱导后，患者行气管插管并机械通气。通过桡动脉置管，采用一种新的脉搏轮廓分析方法——压力记录分析法（PRAM）获取血流动力学数据。在麻醉诱导后（Tbas）、气腹时（T0）、气腹诱导后1、3、5、10、30和60分钟（T1、T3、T5、T10、T15、T30、T60）、腹腔放气时（Tdef）以及放气后5分钟（T5def）记录数据。

结果

气腹后平均动脉压（MAP）升高，放气后恢复至基线水平（Tbas时79±7 mmHg，T5def时81±6 mmHg）。心率（HR）保持不变。气腹诱导后全身血管阻力指数（SVRI）升高，并逐渐恢复至基线水平（Tbas时3,903±330 dyn s m² cm⁻⁵，T1时4,596±148 dyn s m² cm⁻⁵，T5def时3,786±202 dyn s m² cm⁻⁵）。气腹后每搏量指数（SVI）和心脏指数（CI）升高并维持在较高水平。充气后每搏量变异度（SVV）降低，低于基础值（Tbas时28±4%，T5des时15±5%）。充气后心脏周期效率（CCE）短暂降低，随后升高（Tbas时0.029±0.146，T5def时=0.008±0.178）。充气后主动脉dP/dt max升高，仅在放气后恢复至基线水平（Tbas时0.68±0.07 mmHg s⁻¹，T30时0.94±0.08 mmHg s⁻¹，T5def时0.86±0.06 mmHg s⁻¹）。