摘要
目的探究腹腔镜手术气腹压力、体位及时间对下肢深静脉血流速度的影响。方法选取我院2017年10月至2019年6月行妇科腔镜手术患者90例为研究对象,据随机数字法分为3组,各30例;A组气腹压力为11 mmHg,B组气腹压力为13 mmHg,C组气腹压力为15 mmHg,观察在3组平卧麻醉前后、气腹建立0 min、30 min、60 min及手术结束后各阶段下肢深静脉血流速度。结果3组患者气腹建立前,下肢股静脉直径及血流速度未受明显影响,差异无统计学意义(P>0.05),建立气腹后,取头低足高位进行手术治疗,随气腹维持时间延长,患者股静脉直径逐渐增大,深静脉血流速逐渐减小;T3、T4时C组患者股静脉增至最大,深静脉学流速最缓,组间比较差异有统计学意义(P<0.05);C组深静脉血栓(DVT)发生率略高于A、B组,但差异无统计学意义(P>0.05)。结论在腹腔镜手术中,气腹压力过高,气腹维持时间延长都将降低下肢深静脉血流速度,提升术后DVT风险,而头低足高位更加有助下肢深静脉血回流,预防DVT发生。
Objective To investigate the effects of pneumoperitoneal pressure,position and time on deep venous flow velocity in lower extremities during laparoscopic surgery.Methods Ninety patients,who underwent laparoscopic surgery in the Department of Gynecology in our hospital between October 2017 and June 2019,were included as the subjects in the study.All patients were randomly divided into 3 groups(n=30 each).The pneumoperitoneal pressure in groups A,B and C was 11 mmHg,13 mmHg and 15 mmHg,respectively.The deep venous flow velocity in lower extremities was determined in the three groups before and after supine anesthesia,at 0 min,30 min and 60 min after the establishment of pneumoperitoneum,and at different stages after the operation,respectively.Results At the baseline of pneumoperitoneum establishment in the three groups,the diameter of lower extremity femoral vein and blood flow velocity were not significantly affected,with no significant difference(P>0.05).After the pneumoperitoneum was established,the head was lowered and the feet was elevated for surgical treatment.With the prolongation of pneumoperitoneum,the diameter of femoral vein gradually increased,and the deep venous flow velocity in lower extremities gradually decreased.At T3 and T4,the blood flow velocity in femoral vein increased to the maximum in group C,whereas the deep venous flow velocity in lower extremities was the slowest,and there was significant difference between groups(P<0.05).The incidence of deep venous thrombosis(DVT)in group C was slightly higher than that in groups A and B,but there was no significant difference(P>0.05).Conclusion In laparoscopic surgery,excessive pneumoperitoneal pressure and prolongation of pneumoperitoneum may reduce the deep venous flow velocity in lower extremities and increase the risk of postoperative DVT.The position of lowered head and elevated feet favors the deep venous return in lower extremities,and prevent the occurrence of DVT.
作者
印李雅
李和
陈少红
潘琴
余佳佳
陈晓洁
李晓琼
Yin Liya;Li He;Chen Shaohong;Pan Qin;Yu Jiajia;Chen Xiaojie;Li Xiaoqiong(Department of Operating Room,Wenzhou People′s Hospital,Zhejiang 325000,China)
出处
《中国药物与临床》
CAS
2020年第4期518-521,共4页
Chinese Remedies & Clinics
基金
浙江省温州市科技计划经费自筹项目(Y20180406)。
关键词
血流速度
气腹压力
腹腔镜手术
深静脉血栓
Blood flow velocity
Pneumoperitoneum pressure
Laparoscopic surgery
Deep venous thrombosis
