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目的观察间歇充气加压对腹腔镜胃癌手术患者下肢深静脉血流动力学的影响,并探讨其可能机制。方法将腹腔镜胃癌手术患者随机分成使用间歇充气加压组(实验组)和不使用间歇充气加压组(对照组),通过彩色多普勒方法测定手术过程中不同时间点股静脉直径、血流速度及血流量。结果与气腹前平卧位相比,两组气腹形成后取头高脚低位患者股静脉直径均增大,平均血流速度及血流量均降低(P<0.01);术中,随着手术时间的延长,股静脉直径无明显变化,但平均血流速度及血流量均显著减少(P<0.05);至术毕CO2气体排出后、麻醉恢复前取平卧位时股静脉直径变细(P<0.01),平均血流速度及血流量均增加(P<0.01),但仍达不到气腹前平卧位水平(P<0.05)。实验组手术过程中,股静脉、平均血流速度及血流量均维持在较稳定状态。两组间各时间点血流动力学指标差异有统计学意义(P<0.05,P<0.01)。结论间歇充气加压可有效改善腹腔镜胃癌手术操作(CO2气腹建立、头高脚低位及手术时间延长)所致的股静脉血流动力学变化(管径变粗、血流速度减慢、血流量减少),降低术后下肢深静脉血栓发生的风险。
Objective To observe the effect of intermittent inflation on the hemodynamics of deep venous legs in patients undergoing laparoscopic surgery for gastric cancer and to explore its possible mechanism. Methods Patients undergoing laparoscopic surgery for gastric cancer were randomly divided into intermittent inflatable group (experimental group) and non-intermittent inflatable group (control group). The diameter of femoral vein and blood at different time points during operation were measured by color Doppler flow imaging Flow velocity and blood flow. Results Compared with the supine position before pneumoperitoneum, the diameter of the femoral vein in both groups after the pneumoperitoneum was increased and the average blood flow velocity and blood flow decreased (P <0.01). During the operation, With prolongation of time, there was no significant change in the diameter of femoral vein, but the average blood flow velocity and blood flow decreased significantly (P <0.05). After CO2 gas excretion was obtained, the femoral vein diameter became thinner P <0.01), mean blood flow velocity and blood flow increased (P <0.01), but still not reach the level of supine before pneumoperitoneum (P <0.05). During the operation of the experimental group, the femoral vein, average blood flow velocity and blood flow were maintained at a relatively stable state. There was significant difference of hemodynamics between the two groups at each time point (P <0.05, P <0.01). Conclusion Intermittent inflation can effectively improve the hemodynamic changes of the femoral vein (diameter of the femoral vein becomes thick, the blood flow velocity slows down, the time of operation, Reduce blood flow), reduce the risk of postoperative deep vein thrombosis.