腹腔镜手术中央,周围血流动力学变化及应用IPC后的相应变化.docVIP

腹腔镜手术中央，周围血流动力学变化及应用IPC后的相应变化 Central and Peripheral Adverse Hemodynamic Changes During Laparoscopic Surgery and Their Reversal with a Novel Intermittent Sequential Pneumatic Compression Device Siamack Alishahi, FRCS,* Nadir Francis, FRCS,* Sally Crofts, FRCA,+ Lesley Duncan, FRCA,+ Amitati Bickel, MD,* and Alfred Cuschieri, MD, FRSE* From the Departments of *Surgery Molecular Oncology and +Anaesthesia, Ninewells Hospital and Medical School Objective To study the influence of a novel intermittent sequential pneumatic compression device (Lympha-press) on the adverse cardiac and peripheral hemodynamic changes induced by positive-pressure pneumoperitoneum (PPPn) in laparoscopic surgery. Summary Background Data Creation of PPPn is known to cause adverse central and peripheral hemodynamic changes. An intrasubject observational study was undertaken to quantitate these adverse changes and to assess the influence of an intermittent sequential pneumatic compression system on these adverse hemodynamic changes during laparoscopic surgery with PPPn. Methods The study involved 16 consecutive patients undergoing laparoscopic surgery with PPPn of 12 mmHg and 30o head-up tilt position. The following peripheral hemodynamic recordings were made using Doppler ultrasound: peak systolic velocity (PSV), end diastolic velocity (EDV), and cross-sectional area of the femoral vein. Central monitoring included cardiac output and stroke volume by transesophageal Doppler, blood pres-sure, and pulse. The hemodynamic state based on these parameters was assessed before induction of PPPn with the anesthetized patient in the supine position, after induction of PPPn and head-up tilt position with Lympha-press off, and during PPPn and head-up tilt position with Lympha-press on, and after. desufflation with the patient in the supine position under general anesthesia. Results Positive-pressure pneumoperitoneum and the head-up tilt position resulted in a 33% reduction in PSV, a 21% reduction in EDV, an