Centre of Anaesthesiology and Intensive Care, University of Hamburg, Germany.
Int J Med Robot. 2011 Dec;7(4):408-13. doi: 10.1002/rcs.410. Epub 2011 Aug 3.
Robotic-assisted laparoscopic prostatectomy (RALP) is usually performed in steep Trendelenburg position, which can be associated with cardiac impairment due to positioning and capnoperitoneum. This study investigated haemodynamic consequences and cardiac function in this type of surgery and evaluated the hypothesis that steep Trendelenburg position and capnoperitoneum results in haemodynamic and ventricular impairment.
10 patients (ASA I-III) scheduled for RALP in steep Trendelenburg position with capnoperitoneum were prospectively studied. Heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded. Stroke volume variation (SVV) and cardiac output (CO) were measured using pulse-contour analysis. Further, cardiac function was assessed using trans-oesophageal echocardiography before positioning (T1) and 10 min (T2) and 60 min (T3) after implementation of steep Trendelenburg position and capnoperitoneum.
HR did not change statistically. MAP (T1, 69.7 ± 1.55; T2, 82.9 ± 3.05; T3, 79.4 ± 2.18 mmHg), CVP (T1, 7.7 ± 1.3; T2, 17.3 ± 2.01; T3, 16.9 ± 1.66 mmHg) and CO (T1, 4.0 ± 0.15; T2, 4.9 ± 0.26; T3, 4.9 ± 0.36 l/min) increased significantly at T2 and T3. Echocardiography showed no deterioration of left or right ventricular function. In one patient with pre-existing mitral valve insufficiency (I°) an aggravation of the insufficiency (III°) was observed. No other valve dysfunctions were observed.
The steep Trendelenburg position may improve haemodynamic function and does not deteriorate left or right ventricular function during RALP. However, mitral valve insufficiency may be aggravated by positioning and capnoperitoneum.
机器人辅助腹腔镜前列腺切除术（RALP）通常在头高脚低位进行，这种体位加上二氧化碳气腹可能导致心脏受损。本研究旨在探讨这种手术中的血液动力学变化和心功能，并验证头高脚低位和二氧化碳气腹会导致血液动力学和心室功能受损的假设。
前瞻性研究了 10 例 ASA I-III 级择期行 RALP 的患者，采用头高脚低位并建立二氧化碳气腹。记录心率（HR）、平均动脉压（MAP）和中心静脉压（CVP）。采用脉搏轮廓分析法测量每搏量变异（SVV）和心输出量（CO）。另外，在摆放头高脚低位和建立二氧化碳气腹前（T1）、摆放后 10 分钟（T2）和 60 分钟（T3）时，使用经食管超声心动图评估心功能。
HR 无统计学差异。MAP（T1：69.7±1.55mmHg；T2：82.9±3.05mmHg；T3：79.4±2.18mmHg）、CVP（T1：7.7±1.3mmHg；T2：17.3±2.01mmHg；T3：16.9±1.66mmHg）和 CO（T1：4.0±0.15l/min；T2：4.9±0.26l/min；T3：4.9±0.36l/min）在 T2 和 T3 时显著升高。超声心动图显示左、右心室功能无恶化。在 1 例存在二尖瓣关闭不全（I°）的患者中，观察到关闭不全加重（III°）。未发现其他瓣膜功能障碍。
在 RALP 中，头高脚低位可能改善血液动力学功能，且不会导致左、右心室功能恶化。然而，体位和二氧化碳气腹可能会加重二尖瓣关闭不全。
