Safran D, Sgambati S, Orlando R
Department of Surgery, Hartford Hospital, Connecticut 06115.
Surg Gynecol Obstet. 1993 Jun;176(6):548-54.
Fifteen patients with severe cardiac disease (American Society of Anesthesiologists III or IV) underwent laparoscopy using radial artery and pulmonary artery catheters to determine intraoperative hemodynamic changes. Cardiac output (CO), mean arterial blood pressure (MAP), central venous pressure, heart rate, systemic vascular resistance (SVR) and mixed venous oxygen saturation (SVO2) were recorded before anesthetic induction, after induction, but before peritoneal insufflation, after insufflation and after release of pneumoperitoneum. Peritoneal insufflation led to significant elevations in MAP and SVR and reduction in CO. For seven patients, a decrease in SVO2 after peritoneal insufflation was predictive of significant worsening of hemodynamic parameters, suggesting inadequate cardiac reserve. In all patients, hemodynamic parameters returned toward baseline once pneumoperitoneum was released. There were no perioperative cardiac complications. While it is evident that laparoscopy presents serious hemodynamic stress, it can be performed safely in high-risk patients, using aggressive intraoperative monitoring.
15例患有严重心脏病（美国麻醉医师协会分级III或IV级）的患者接受了腹腔镜检查，术中使用桡动脉和肺动脉导管以确定血流动力学变化。在麻醉诱导前、诱导后但在气腹前、气腹后以及气腹解除后记录心输出量（CO）、平均动脉血压（MAP）、中心静脉压、心率、全身血管阻力（SVR）和混合静脉血氧饱和度（SVO2）。气腹导致MAP和SVR显著升高以及CO降低。对于7例患者，气腹后SVO2降低预示着血流动力学参数显著恶化，提示心脏储备不足。在所有患者中，一旦气腹解除，血流动力学参数即恢复至基线水平。围手术期无心脏并发症。虽然腹腔镜检查显然会带来严重的血流动力学应激，但在高危患者中使用积极的术中监测可安全进行。
