摘要
目的 研究妇科腹腔镜手术中气腹和体位对患者下肢静脉血液动力学的影响。方法 妇科腹腔镜手术患者 18例 ,在相同的CO2 气腹压力 (12mmHg)及不同的体位下 ,用彩色多普勒超声测量患者右下肢股静脉的直径及血流速度 ,然后通过公式Q =vπr2 计算出股静脉的血流量。比较CO2 气腹前后及不同的体位下上述各指标的差异。结果 CO2 气腹形成后 ,股静脉明显扩张 ,血流速度明显减慢 ,血流量明显减少 ;30度头低脚高体位使股静脉的血流速度加快 ,血流量增加 ,直径变小 ;30度头低脚高体位 30min时 ,股静脉的血流仍比气腹形成后的平卧位明显改善 ;气腹排除后股静脉仍处于扩张状态。结论 腹腔镜手术中CO2 气腹引起了下肢静脉血流阻滞 ,30度头低脚高体位可改善下肢静脉的血液回流 ,气腹的排除短时内不能完全解除CO2 气腹引起的下肢静脉的扩张。
Objective To study the effect of CO 2 pneumoperitoneum on the venous diameter,blood velocity and blood flow in the femoral vein under the special surgical position of 30 degree head-down tilt position. Methods Color duplex ultrasound was adopted to evaluate the diameter and blood velocity in the lower extremity of the eighteen patients undergoing gynecologic laparoscopy before and after the establishment of pneumoperitoneum of 12 mmHg and under different positions.The amount of the blood flow was calculated with the equation of Q=vπr 2. Results After the establishment of pneumoperitoneum,the dilation of the femoral vein,the decrease in both the velocity and amount of blood flow can be observed.And the 30 degree head-down tilt position can increase the velocity and amount of blood flow and decrease the diameter of the femoral vein.After 30 minutes of the 30 degree head-down tilt position,the blood flow was ameliorated compared to that at the prone position after pneumoperitoneum.After expelling CO 2,the femoral vein remained dilated. Conclusions During laparoscopy,the CO 2 pneumoperitoneum may result in the dilation of the vein in the lower extremity and the blood flow retarding.The 30 degree head-down tilt position can ameliorate the blood flow in the lower extremity.Release of CO 2 cannot eliminate the effect of CO 2 pneumoperitoneum on the lower extremity veins,which predisposes DVT after laparoscopy.
出处
《中国妇产科临床杂志》
2004年第5期332-335,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
