체위 변화에 따른 복강경 수술의 혈역학적 변화의 비교

Background: The authors evaluated the hemodynamic effects of body position measured by esophageal Doppler monitor (EDM) during laparoscopic cholecystectomy or gynecologic laparoscopic surgery. Methods: Fifty patients scheduled to undergo laparoscopic cholecystectomy (Group C) or gynecologic laparoscopic surgery (Group G), were divided into two groups. Pneumoperitoneum was instituted by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after changing position (T2, T3 and T4), and 5 min after CO2 exsufflation (T5). Results: MAP (mean arterial pressure) was significantly higher in Group G when compared with Group C 10 min after changing position (T3) (P ＜ 0.05). CO (cardiac output) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P ＜ 0.05). And there were not significant differences in HR (heart rate) between two groups. PV (peak velocity) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P ＜ 0.05). And there were not significant differences in FTc (corrected flow time) between two groups. But FTc in Group C was restored after CO2 exsufflation, FTc in Group G was not restored after CO2 exsufflation. Conclusions: Changing position in the gynecologic laparoscopic surgery group can elevate MAP and decrease CO. Therefore, careful caution is required in patients with cardiovascular disease who are undergoing gynecologic laparoscopic surgery. KCI Citation Count: 1