腹腔鏡手術 の 心血管 と 呼吸器 の 影響
Tamara M Atkinson1, George D Giraud1, Brandon M Togioka1
1From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.).
Circulation
|February 15, 2017
まとめ
特に心血管疾患の患者では,二酸化炭素の吸入が血液動力学と呼吸に影響するので, laparoscopic 手術はリスクがあります. これらの一般的な手続きの際の合併症を防ぐには,多学科的なアプローチが不可欠です.
科学分野:
- 外科 革新
- 麻酔科
- 心血管の生理学
背景:
- laparoscopic 手術は広く実施されている (年間200万件以上).
- 現在のリスクスコアは 腹腔鏡手術のリスクを 十分に評価していません
- ラパロスコピーは通常,オープン手術よりも低い罹病率/死亡率を持っています.
研究 の 目的:
- 腹腔鏡手術の 血液動力学と呼吸器の影響を 強調するためです
- リスク評価と合併症予防戦略の改善の必要性を強調する.
- 腹腔鏡手術を受ける患者の管理における多学科アプローチの重要性を強調する.
主な方法:
- 腹腔鏡検査中の二酸化炭素吸入による生理学的効果のレビュー
- 血液動力学と呼吸器の変化の分析
- リスクの高い患者集団 (例えば心臓血管疾患) の特定
主要な成果:
- 二酸化炭素吸入は腹腔内圧を増加させ,血動力学的変化 (後押し/前押しの増加,心臓の出力量の減少) を引き起こします.
- 呼吸器への影響は 呼吸道圧力の上昇と 肺の高血圧です
- 心血管疾患の患者は血動力学的効果が顕著である.
結論:
- 腹腔鏡手術の生理学的影響を理解することは 心血管の合併症を予防する鍵です
- 多学科チーム (コンサルタント,麻酔医,外科医) が作成した明確な手術計画が不可欠です.
- 安全な腹腔鏡手術を行うためには 術前リスク評価と管理の改善が必要である.
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