摘要
目的·观察稳压气腹模式与传统气腹模式对腹腔镜手术患者下肢深静脉血流速度的影响。方法·根据便利抽样法选择2021年4月-2021年9月于上海交通大学医学院附属瑞金医院行腹腔镜下腹盆腔恶性肿瘤手术的患者共60例,比较采用稳压气腹模式的患者(观察组,n=30)与采用传统气腹模式的患者(对照组,n=30)在麻醉开始前(T0)、麻醉后(T1)、CO_(2)气腹建立稳定后(T2)、气腹60 min(T3)、气腹120 min(T4)、气腹结束(T5)各时间点下肢深静脉血流速度,包括收缩期静脉血流峰速度(peak systolic velocity,PSV)和舒张期静脉血流速度(end diastolic velocity,EDV)。手术前24 h、手术后24 h分别抽取患者外周静脉血行凝血功能检测,监测活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)及D-二聚体(D-dimer,D-D)值。结果·CO_(2)气腹导致下肢深静脉血流速度变缓。重复测量方差分析结果显示:PSV,F_(时间)=1253.171,F_(组间)=4.905,F_(交互)=13.338,均P<0.05;EDV,F_(时间)=1046.798,F_(组间)=21.163,F_(交互)=11.090,均P<0.01。各时间点2组间存在交互效应,传统气腹模式对PSV、EDV影响较大。2组不同时间点血流速度差比较结果显示,随着气腹时间延长,在T3、T4、T5时间点,观察组患者血流速度差值明显低于对照组(P<0.05)。2组患者术后24 h APTT、PT及D⁃D值与术前组内比较,差异均有统计学意义(均P=0.000)。2组深静脉血栓形成的发生率比较,差异无统计学意义(χ^(2)=0.215,P=1.000)。结论·稳压气腹与传统气腹均对患者下肢深静脉血流存在影响;对手术及气腹时间较长的腹腔镜手术患者使用稳压气腹可延缓其下肢血流速度下降。
Objective·To investigate the effects of stabilized pneumoperitoneum and traditional pneumoperitoneum on the blood flow velocity of the lower extremity deep veins in the patients undergoing laparoscopic surgery.Methods·According to the convenience sampling method,a total of 60 patients undergoing laparoscopic abdominal and pelvic malignant tumor surgeries in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from April 2021 to September 2021 were selected,and the stabilized pneumoperitoneum group(n=30)and the traditional pneumoperitoneum group(n=30)were compared at T0(before anesthesia),T1(after anesthesia),T2(after pneumoperitoneum stabilization),T3(pneumoperitoneum at 60 min),T4(pneumoperitoneum at 120 min),and T5(after pneumoperitoneum)in blood flow velocity including peak systolic velocity(PSV)and end diastolic velocity(EDV).The activated partial thromboplastin time(APTT),prothrombin time(PT)and D‐dimer(D-D)were detected at 24 h before and after surgery.Results·CO_(2) pneumoperitoneum slowed down the blood flow velocity of lower extremity deep veins.Repeated measurement ANOVA analysis showed the values of F_(time),F_(group) and F_(interaction) were 1253.171,4.905 and 13.338(P<0.05),respectively for PSV,and 1046.798,21.163,and 11.090,respectively for EDV(P<0.01).There were great influences on PSV and EDV in the traditional pneumoperitoneum group.With the prolongation of pneumoperitoneum time,the difference of blood flow velocity in the stabilized pneumoperitoneum group was significantly lower than that in the traditional pneumoperitoneum group at T3,T4 and T5 time points(P<0.05).There were statistically significant differences in APTT,PT and D D between the two groups at 24 h before and after surgery(P=0.000).There was no statistical difference in the incidence of deep vein thrombosis(DVT)between the two groups(χ^(2)=0.215,P=1.000).Conclusion·Stabilized pneumoperitoneum and traditional pneumoperitoneum have different effects on deep venous blood flow of lower extremities.It is recommended to use stabilized pneumoperitoneum to slow down the decrease of lower limb blood flow velocity for patients undergoing a long time laparoscopic surgery.
作者
孙惠华
田秋菊
吴蓓雯
SUN Huihua;TIAN Qiuju;WU Beiwen(Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China;Department of Nursing,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2022年第9期1329-1335,共7页
Journal of Shanghai Jiao tong University:Medical Science
基金
上海交通大学医学院2021年护理学科人才队伍建设项目(2021-21)。
关键词
血流速度
腹腔镜手术
气腹压力
深静脉血栓
blood flow velocity
laparoscopic surgery
pneumoperitoneum pressure
deep venous thrombosis
