腹腔镜手术对心血管和呼吸系统的影响
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
概括
由于二氧化碳吸入影响血液动力学和通风,腹腔镜手术存在风险,特别是在心血管疾病患者中. 跨学科的方法对于预防这些常见程序的并发症至关重要.
科学领域:
- 外科创新
- 麻醉学
- 心血管生理学
背景情况:
- 腹腔镜手术是广泛进行的 (每年超过200万次手术).
- 目前的风险评分不足以评估腹腔镜手术的风险.
- 腹腔镜手术的发病率/死亡率通常低于开放手术.
研究的目的:
- 突出腹腔镜手术对血液动力学和呼吸系统的影响.
- 强调需要改进风险评估和预防并发症的战略.
- 强调在进行腹腔镜手术的患者管理中多学科方法的重要性.
主要方法:
- 在腹腔镜检查过程中对二氧化碳吸入的生理影响的回顾.
- 血液动力学和呼吸系统变化的分析.
- 确定患有较高风险的患者群体 (例如心血管疾病).
主要成果:
- 二氧化碳吸入会增加腹腔内压力,导致血液动力学变化 (增加后负荷/预负荷,心脏输出量减少).
- 呼吸系统的后果包括增加的呼吸道压力和高心力.
- 心血管疾病患者的血液动力效应加剧.
结论:
- 了解腹腔镜手术的生理影响是预防心血管并发症的关键.
- 一个由多学科团队 (顾问,麻醉师,外科医生) 制定的确定的手术计划是必不可少的.
- 需要改善手术前风险评估和管理,以确保腹腔镜手术的安全性.
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