■腹腔镜手术导致腹内压增加和隔膜的头颅移位。Trendelenburg位置可以增强这些呼吸变化。这项研究的主要目的是使用超声检查(USG)比较在全身麻醉下在Trendelenburg位置进行腹腔镜盆腔大手术前后的the肌偏移。
■这项前瞻性观察研究包括90名男女患者,20-60岁,与美国麻醉医师协会的身体状况I/II。在麻醉诱导前和气管拔管后10分钟,使用M模式USG评估隔膜吸气幅度(DIA)。年龄等因素,性别,身体质量指数,呼气末正压(PEEP),疼痛,峰值气道压,气腹的持续时间,记录Trendelenburg位置的持续时间和程度以及麻醉持续时间.采用Pearson相关和多元线性回归分析影响DIA(ΔDIA)变化的因素。
■测得的DIA的平均差(95%置信区间(CI))为0.70(0.598-0.809),P<0.001。ΔDIA与年龄呈弱正相关,麻醉持续时间,气腹,拔管后10分钟进行视觉模拟评分(VAS)。多元线性回归分析显示DIA的方差为14.86%。年龄(β=0.008,P=0.049),麻醉时间(β=0.002,P=0.02)和拔管后10分钟VAS评分(β=0.128,P=0.001)是有意义的独立预测因素。
■在Trendelenburg位置进行盆腔腹腔镜手术后DIA显著降低。年龄,麻醉持续时间和术后疼痛是重要的独立预测因素。
UNASSIGNED: Laparoscopic surgeries result in increased intra abdominal pressure and cephalad displacement of the diaphragm. The Trendelenburg position can augment these respiratory changes. The primary objective of this study was to compare diaphragmatic excursions before and after a major laparoscopic pelvic surgery under general anaesthesia in the Trendelenburg position using ultrasonography (USG).
UNASSIGNED: This prospective observational study included 90 patients of either gender, aged 20-60 years, with American Society of Anesthesiologists physical status I/II. M-mode USG was used to assess diaphragm inspiratory amplitude (DIA) before induction of anaesthesia and 10 minutes after tracheal extubation. Factors such as age, gender, body mass index, positive end-expiratory pressure (PEEP), pain, peak airway pressures, duration of pneumoperitoneum, duration and degree of Trendelenburg position and duration of anaesthesia were recorded. Pearson\'s correlation and multiple linear regression were used to analyse the factors affecting change in DIA (ΔDIA).
UNASSIGNED: The mean difference (95% confidence interval (CI)) of measured DIA was 0.70 (0.598-0.809), P < 0.001. ΔDIA had a weak positive significant correlation with age, anaesthesia duration, pneumoperitoneum, and visual analogue scale (VAS) score 10 minutes after extubation. Multiple linear regression analysis showed 14.86% of the variance in DIA. Age (β = 0.008, P = 0.049), duration of anaesthesia (β = 0.002, P = 0.02) and VAS score 10 minutes after extubation (β = 0.128, P = 0.001) were significant independent predictors.
UNASSIGNED: DIA decreased significantly after pelvic laparoscopic surgeries performed in the Trendelenburg position. Age, duration of anaesthesia and pain after the procedure were significant independent predictors.