腹腔镜胆囊切除术中腹部充气后静脉淤滞的证据。

Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy.

作者信息

Beebe D S, McNevin M P, Crain J M, Letourneau J G, Belani K G, Abrams J A, Goodale R L

机构信息

Department of Anesthesiology, University of Minnesota Hospital and Clinic, Minneapolis.

出版信息

Surg Gynecol Obstet. 1993 May;176(5):443-7.

PMID:8480266

Abstract

Intraoperative venous stasis may increase the risk for perioperative deep vein thrombosis and pulmonary embolism. To determine if abdominal insufflation during laparoscopic cholecystectomy causes venous stasis, eight patients undergoing this procedure had their left common femoral veins examined by a duplex scanner before and after abdominal insufflation; the veins then were examined again before and after deflation. The right femoral veins were catheterized to measure femoral venous pressures. Abdominal insufflation to 14 millimeters of mercury pressure increased femoral venous pressures (10.2 +/- 4.1 millimeters of mercury to 18.2 +/- 5.1 millimeters of mercury; p < 0.001) and slowed peak blood velocities (24.9 +/- 8.5 centimeters per second to 18.5 +/- 4.5 centimeters per second; p < 0.05) without changing the cross-sectional areas (1.1 +/- 0.4 centimeter squared to 1.2 +/- 1.5 centimeter squared; p = NS) of the common femoral veins. Insufflation also reduced or eliminated pulsatility in the common femoral veins in 75 percent of the patients, indicating that insufflation was causing partial proximal venous obstruction. After 80 +/- 21 minutes of surgery, these changes remained significant. Deflation of the abdomen restored normal venous pulsatility in all patients, reduced femoral venous pressures (18.5 +/- 5.2 millimeters of mercury to 12.2 +/- 9.8 millimeters of mercury; p < 0.001), increased the peak blood velocities (14.2 +/- 6.8 centimeters per second to 28.1 +/- 16 centimeters per second; p < 0.05) and decreased the cross-sectional areas (1.4 +/- 0.6 centimeters squared to 0.9 +/- 0.4 centimeters squared; p < 0.05) of the common femoral veins, indicating venous decompression had occurred. The results suggest abdominal insufflation causes venous stasis during laparoscopic cholecystectomies. Measures shown to reduce intraoperative venous stasis, such as pneumatic compressive stockings, may benefit patients undergoing these procedures.

摘要

术中静脉淤滞可能会增加围手术期深静脉血栓形成和肺栓塞的风险。为了确定腹腔镜胆囊切除术期间的腹部充气是否会导致静脉淤滞，8例接受该手术的患者在腹部充气前后通过双功扫描仪检查其左股总静脉；然后在放气前后再次检查静脉。通过右股静脉插管测量股静脉压力。将腹部充气至14毫米汞柱压力会增加股静脉压力（从10.2±4.1毫米汞柱增至18.2±5.1毫米汞柱；p<0.001）并减慢峰值血流速度（从24.9±8.5厘米/秒降至18.5±4.5厘米/秒；p<0.05），而股总静脉的横截面积不变（从1.1±0.4平方厘米变为1.2±1.5平方厘米；p=无显著差异）。充气还使75%的患者股总静脉的搏动性减弱或消失，表明充气导致了部分近端静脉阻塞。手术80±21分钟后，这些变化仍然显著。腹部放气使所有患者的静脉搏动恢复正常，降低了股静脉压力（从18.5±5.2毫米汞柱降至12.2±9.8毫米汞柱；p<0.001），增加了峰值血流速度（从14.2±6.8厘米/秒增至28.1±16厘米/秒；p<0.05），并减小了股总静脉的横截面积（从1.4±0.6平方厘米降至0.9±0.4平方厘米；p<0.05），表明发生了静脉减压。结果表明，腹部充气在腹腔镜胆囊切除术期间会导致静脉淤滞。已证明可减少术中静脉淤滞的措施，如气动加压袜，可能会使接受这些手术的患者受益。