Ono Naomi, Nakahira Junko, Nakano Shoko, Sawai Toshiyuki, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
BMC Res Notes. 2017 Jul 28;10(1):341. doi: 10.1186/s13104-017-2672-z.
Robot-assisted laparoscopic prostatectomy requires the patient to be placed in a steep head-down tilt. The aim of our study was to investigate changes in cardiac index and left ventricular end-diastolic volume in a steep had-down tilt. This is a prospective observational study. We investigated the influence of steep head-down tilt on cardiac function and hemodynamics without fluid restriction in 12 men of American Society of Anesthesiologists physical status I-II undergoing robot-assisted laparoscopic prostatectomy. We measured left ventricular ejection fraction, left ventricular end-diastolic volume and cardiac index by transesophageal echocardiography, cardiac index using a FloTrac sensor, heart rate and arterial blood pressure, before and 5 min after tilting the operating table.
The following variables changed significantly after tilting and establishment of the pneumoperitoneum: left ventricular ejection fraction (before 62.5%, after 55.5%; P = 0.040), systolic blood pressure (before 116 mmHg, after 128 mmHg; P = 0.001) and diastolic blood pressure (before 59 mmHg, after 70 mmHg; P = 0.002). There were no significant changes in cardiac index or left ventricular end-diastolic volume measured by transesophageal echocardiography, or cardiac index by FloTrac sensor. Left ventricular ejection fraction decreased, whereas cardiac index and left ventricular end-diastolic volume did not change, indicating that steep head-down tilt and pneumoperitoneum during robot-assisted laparoscopic prostatectomy did not greatly influence cardiac function. This study was registered as a clinical study with the Japanese Official Clinical Trial Registry (Trial Registration Number JMA-IIA00158 on 7th January, 2014).
机器人辅助腹腔镜前列腺切除术要求患者采取头低脚高的大幅倾斜体位。我们研究的目的是调查在头低脚高的大幅倾斜体位下心脏指数和左心室舒张末期容积的变化。这是一项前瞻性观察研究。我们调查了头低脚高的大幅倾斜体位对12例美国麻醉医师协会身体状况为I-II级、正在接受机器人辅助腹腔镜前列腺切除术的男性患者心脏功能和血流动力学的影响，且不限制液体入量。我们在手术台倾斜前及倾斜后5分钟，通过经食管超声心动图测量左心室射血分数、左心室舒张末期容积和心脏指数，使用FloTrac传感器测量心脏指数，同时测量心率和动脉血压。
在倾斜体位并建立气腹后，以下变量发生了显著变化：左心室射血分数（倾斜前62.5%，倾斜后55.5%；P = 0.040）、收缩压（倾斜前116 mmHg，倾斜后128 mmHg；P = 0.001）和舒张压（倾斜前59 mmHg，倾斜后70 mmHg；P = 0.002）。经食管超声心动图测量的心脏指数或左心室舒张末期容积，以及FloTrac传感器测量的心脏指数均无显著变化。左心室射血分数降低，而心脏指数和左心室舒张末期容积未改变，这表明机器人辅助腹腔镜前列腺切除术期间的头低脚高大幅倾斜体位和气腹对心脏功能影响不大。本研究已在日本官方临床试验注册中心注册为临床研究（试验注册号：2014年1月7日JMA-IIA00158）。
