Elliott S, Savill P, Eckersall S
Department of Anaesthetics, Lister Hospital, Stevenage, Hertfordshire, United Kingdom.
Eur J Anaesthesiol. 1998 Jan;15(1):50-5. doi: 10.1046/j.1365-2346.1998.00227.x.
A transoesophageal Doppler cardiac output monitor was used to study the cardiovascular changes occurring during laparoscopic cholecystectomy in patients without (group A) or with (group B) a history of cardiovascular disease, i.e. hypertension, ischaemic heart disease or heart failure. Insufflation of the abdomen with carbon dioxide caused significant (P < 0.01) falls in mean cardiac index (17.9% in group A, 25.1% in group B) and mean stroke volume index (15.3% in group A, 21.2% in group B). Simultaneously, there was a significant (P < 0.05) increase in mean systolic blood pressure (19.4%) in group A. There were no other differences in the cardiovascular responses of the two groups. There was no correlation between systolic blood pressure and either cardiac index or stroke volume index. No significant complications or morbidity were associated with the use of the transoesophageal Doppler monitor. We conclude that the cardiovascular changes associated with insufflation are neither predictable by clinical assessment nor adequately determined by routine monitoring. We recommend the transoesophageal Doppler monitor for use in this situation.
使用经食管多普勒心输出量监测仪，研究无心血管疾病病史（A组）或有心血管疾病病史（B组，即患有高血压、缺血性心脏病或心力衰竭）的患者在腹腔镜胆囊切除术期间发生的心血管变化。向腹腔内注入二氧化碳导致平均心脏指数显著下降（P<0.01）（A组下降17.9%，B组下降25.1%），平均每搏量指数也显著下降（A组下降15.3%，B组下降21.2%）。同时，A组平均收缩压显著升高（19.4%，P<0.05）。两组的心血管反应无其他差异。收缩压与心脏指数或每搏量指数之间无相关性。使用经食管多普勒监测仪未出现明显并发症或发病率增加的情况。我们得出结论，与腹腔充气相关的心血管变化既不能通过临床评估预测，也不能通过常规监测充分确定。我们建议在这种情况下使用经食管多普勒监测仪。
