Effect Of Different Position And Hypophysin On Coronary Artery Blood Flow Status During Laparoscopic Surgery Evaluated By Transesophageal Echocardiography

Objective: To evaluate the influence of coronary artery blood flow status by Transesophageal Echocardiography(TEE) during laparoscopic surgery under different position and hypophysin. Providing the basis of perioperative blood flow dynamic management for the patient who are suffering from cardiovascular diseases and cardiopulmonary function is not completed. Methods: 1.Different position laparoscopic group:54 patients,ASA class ⅠorⅡ, scheduled for elective laparoscopic surgery arranged under general anesthesia were included in this study. The patients were randomly allocated into two groups according to their posture during laparoscopy(n = 27 for each group). In group A the patients were arranged in Trendelenburg position( angle less than 40 degree) and in group B in a head-up tilt position(angle less than 30 degree) according to the requirement of the operation. Heart rate(HR), paw airway pressure(PAW), End-tidal carbon dioxide partial pressure(PETCO2), mean arterial pressure(MAP)were monitored continuously and recorded after the induction of anesthesia 10min(T1), after peritoneal insufflation 5min(T2), after arranging position 5 min(T3), 10 min(T4), and 15 min(T5),respectively. Diameters of the initiation of left anterior descending coronary arteries(LAD) were measured by TEE and minute blood flow were also calculated and recorded at every time points. TEE was used for detecting movement of ventricular wall. 2. Hypophysin group: 18 patients,ASA class Ⅰ or Ⅱ, scheduled for elective gynecologicallaparoscopic surgery under general anesthesia were included in this study. Heart rate(HR), paw airway pressure(PAW), End-tidal carbon dioxide partial pressure(PETCO2), mean arterial pressure(MAP)were monitored continuously and recorded after the induction of anesthesia 10min(T1), after peritoneal insufflation 5min(T2),after arranging in Trendelenburg position 5 min(T3), before the injection of hypophysin 2 min(T4), 2 min after the injection of hypophysin(T5), 5 min after the injection of hypophysin(T6),respectively. Diameters of the initiation of left anterior descending coronary arteries and the Velocity Time integral(VTI) were measured by Transesophageal Echocardiography(TEE) and minute blood flow were also calculated and recorded at every time points. Results: 1.Different position laparoscopic group: 49 patients completed this study.(1)Intra-group comparison: Compared with T1, PAW at T2, T3, T4, T5 increased significantly in both groups(p<0.05); Compared with T1, PAW at T2, T3, T4, T5 increased significantly in group B(p<0.05); Compared with T1, diameters of the initiation of left anterior descending coronary arteries and minute blood flow decreased significantly in both groups(p<0.05); Compared with T2, diameters of the initiation of left anterior descending coronary arteries and minute blood flow decreased significantly in group A(p<0.05).(2) Inter-group comparison: Compared with group B, HR at T2, T3, T4, T5 didn’t increase significantly(p<0.05); Compared with group B, PAW at T2, T3,T4, T5 increased significantly(p<0.05); Compared with group B, LAD blood flow and VTI at T2, T3, T4, T5 decreased significantly(p < 0.05); There was no Regional Wall Motion Abnormalities(RWMA) in the observation period. 2.Hypophysin group: 18 patients completed this study. Compared with T1, PAW and HR at T2, T3, T4, T5, T6 increased significantly(p<0.05). Compared with T4, HR and MAP at T5 and T6 increased significantly(p<0.05). Compared with T1, diameters of the initiation of left anterior descending coronary arteries and minute blood flow decreased significantly, respectively.(p<0.05). Compared with T4,minute blood flow and VTI increased significantly, respectively(p<0.05).There were no significantly changes in PETCO2 at every time points(p>0.05).Conclusion: 1.The different position may have obvious effect on coronary artery blood flow during laparoscopic surgery.TheTrendelenburg position can reduce the coronary artery blood flow to a great extent accounting for many of the adverse effects on patients with cardiovascular disease.2.12 U hypophysin is safe to use during laparoscopic surgery.The hypophysin can not cause the coronary artery blood flow to drop.