摘要
目的观察妇科腹腔镜手术中控制中心静脉压对患者血浆心钠素(ANP)及眼内压(IOP)的影响。方法选择择期妇科腹腔镜手术患者36例,随机分为控制中心静脉压(CVP)组(CP组,n=18)和对照组(C组,n=18)。两组麻醉诱导及维持用药均相同,调整呼吸参数维持呼气末二氧化碳分压(PETCO2)在35～40 mmHg,CP组于人工气腹前微量泵持续泵注硝酸甘油2～4μg/(kg.min)至手术结束,使CVP控制在10～14 cmH2O。监测并记录麻醉前(T0),气腹建立并改变体位后30 min(T1)、60 min(T2),撤销气腹10 min(T3)时的IOP、CVP及平均动脉压(MAP),并采集两组上述不同时点静脉血样本,用放射免疫法检测血浆ANP含量。结果与C组比较,CP组T1、T2时CVP、MAP、IOP降低(P<0.01),ANP含量增高(P<0.05)。与本组T0时比较,CP组T1、T2CVP增高(P<0.01),但控制在10～14 cmH2O,MAP降低(P<0.01),IOP、ANP差异无统计学意义(P>0.05);C组T1、T2CVP、IOP增高(P<0.01)且CVP>14 cmH2O,ANP降低(P<0.01),MAP差异无统计学意义(P>0.05)。结论妇科腹腔镜手术中降低并维持中心静脉压可使患者血浆ANP分泌增多,抑制眼内压增高,有利于维持患者机体内环境的稳定,提高手术的安全性。
Objective To investigate the influences of central venous pressure on patients＇ intraocular pressure （IOP） and the atrial natriuretic peptide （ANP） during gynecological laparoscopic surgery. Methods 36 patients performed gynecological laparoscopic surgery were randomly divided into group CP （control central venous pressure, n = 18） and control group （group C,n = 18）. The same anesthesia induction method and medication were used in two groups. Minute volume was set to maintain PEr CO2 at 35-40 mmHg. In group CP Nitroglycerin was pumped with the speed 2- 4 μg/（kg ·min） before the artificial pneumoperitoneum for surgery in order to maintain CVP within 10-14 cmH2O. lOP, CVP and MAP were recorded before anesthesia （TO ） , at 30 min after the CO2 pneumoperitoneum and posture changed （T1） , at 60 min （T2） and at 10 rain after CO2 pneumoperitoneum dropped （T3 ）. Venous blood samples were extracted at different time and the content of atrial natriuretic peptide （ANP） was detected by radioimmunoassay method. Results The IOP, CVP and MAP in group CP were decreased at T1-T2 than those in group C （P 〈0. 01 ） ; while the content of ANP was increased （P 〈 0. 05）. MAP in group CP was decreased at T1 -T2 than that at To （ P 〈 0.01 ） , while the MAP was decreased when it maintained within 10-14 cmH2O （P 〈 0.01 ）, and the difference was not statistically significant between IOP and ANP （P 〉 0.05）. The content of CVP and IOP were significantly increased at T1-T2 （P 〈 0.01 ） and when CVP 〉 14 cmH2 O, the content of ANP was decreased in group C （P 〈 0. 01 ）, and the difference was not statistically significant （P 〉 0.05）. Conclusion Reducing the central venous pressure during gynecological laparoscopic surgery may inhibit the intraocular pressure increase and keep patients＇ body environmentally stable.
出处
《解放军医药杂志》
CAS
2012年第11期23-25,共3页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
关键词
妇科外科手术
腹腔镜检查
中心静脉压
心钠素
眼内压
Gynecologic surgical procedures
Laparoscopy
Central venous pressure
Atrial natriuretic peptide
Intraocular pressure
