Millard J A, Hill B B, Cook P S, Fenoglio M E, Stahlgren L H
Department of Surgery, Saint Joseph Hospital, Denver, Colo.
Arch Surg. 1993 Aug;128(8):914-8; discussion 918-9. doi: 10.1001/archsurg.1993.01420200088016.
To determine whether pneumoperitoneum and reverse Trendelenburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compression (ISPC) overcomes this impedance.
Using Doppler ultrasonography, peak systolic velocities in the common femoral vein were measured in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during three intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30 degrees reverse Trendelenburg position (both with and without ISPC). Mean arterial pressure and heart rate were obtained concurrently. Measurements of preoperative and postoperative calf and thigh circumferences were obtained.
A tertiary care center. PATIENT PARTICIPANTS: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria.
Peak systolic velocity, mean arterial pressure, heart rate, and calf and thigh circumferences.
The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30 degrees reverse Trendelenburg position significantly decreased peak systolic velocity in the common femoral vein from a preoperative mean of 0.24 +/- 0.025 m/s to 0.14 +/- 0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to 0.27 +/- 0.021 m/s. The mean difference between preoperative peak systolic velocity and peak systolic velocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03 +/- 0.03 m/s but was not significant. Anesthesia alone caused a mean increase in preoperative peak systolic velocity from 0.24 +/- 0.025 m/s to 0.3 +/- 0.032 m/s. Mean arterial pressure levels, heart rate, and calf and thigh circumferences did not change significantly.
This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.
确定腹腔镜手术期间使用的气腹和头低脚高位是否会阻碍股总静脉血流，以及小腿长度的间歇性序贯气压式循环驱动（ISPC）是否能克服这种阻碍。
使用多普勒超声，对接受腹腔镜胆囊切除术并进行二氧化碳气腹的患者测量股总静脉的收缩期峰值流速。在三个时间段进行测量：术前患者仰卧位时；全身麻醉诱导后患者仰卧位时；气腹至13至15 mmHg后患者处于30度头低脚高位时（有无ISPC两种情况）。同时记录平均动脉压和心率。测量术前及术后小腿和大腿周长。
一家三级医疗中心。
连续选取20例年龄在30至70岁之间（15名女性和5名男性）且接受腹腔镜胆囊切除术并符合纳入标准的患者。
收缩期峰值流速、平均动脉压、心率以及小腿和大腿周长。
气腹至13至15 mmHg并结合30度头低脚高位使股总静脉收缩期峰值流速从术前平均0.24±0.025 m/s显著降至0.14±0.011 m/s，降幅达42%。间歇性序贯气压式循环驱动逆转了这一效应，使收缩期峰值流速恢复至0.27±0.021 m/s。术前收缩期峰值流速与气腹、头低脚高位及ISPC联合作用下收缩期峰值流速的平均差值为0.03±0.03 m/s，但无显著差异。仅麻醉使术前收缩期峰值流速从0.24±0.025 m/s平均增至0.3±0.032 m/s。平均动脉压水平、心率以及小腿和大腿周长无显著变化。
本研究表明，腹腔镜胆囊切除术期间，气腹和头低脚高位会使股总静脉血流显著减少。间歇性序贯气压式循环驱动逆转了这一效应，使收缩期峰值流速恢复正常。
