Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy
Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy
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DOI：
10.1007/s00464-009-0388-4
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发表时间：
2009-11-01
影响因子：
3.1
通讯作者：
Haberal, Mehmet
中科院分区：
文献类型：
--
作者：
Ekici, Yahya;Bozbas, Huseyin;Haberal, Mehmet
背景：在腹腔镜手术患者中，二氧化碳（CO2）充气式引起的血流动力学改变是常见的。这些变化的一个指标是校正后的QT离散度（QTcd），这是心肌功能的一个指标。QTcd的延长与心血管发病率和死亡率有关。我们比较了高压（15mmhg）和低压（7mmhg） CO2气腹对腹腔镜胆囊切除术中QT间期、率校正QT间期（QTc）、QT离散度（QTd）和校正QT离散度（QTcd）的影响。方法采用低压气腹组20例，高压气腹组32例。使用12导联心电图监测心脏变量。所有患者在麻醉诱导前（基线）、气腹创建后立即、CO2充入期间每15分钟、放气后5分钟记录一次连续心电图。两名观察者独立测量QT间期，QTcd使用Bazett公式计算。结果两组患者QT间期和QTc间期均无明显变化。在CO2充气过程中，高压气腹组QTd和QTcd均显著升高，且高压气腹组明显高于低压气腹组。二氧化碳注入引起的变化是可逆的。结论：在高压和低压气腹中，QTd和QTcd的增加与心律失常和心脏事件的风险增加有关。高压气腹组QTd、QTcd明显高于低压气腹组。QT间期的变化与麻醉剂、手术压力、高碳酸血症或二氧化碳注入时间无关。腹内压升高可能是造成这些变化的原因。
Background Hemodynamic changes caused by carbon dioxide (CO2) insufflation occur frequently in patients who undergo laparoscopic surgery. One indicator of these changes is corrected QT dispersion (QTcd), an index of myocardial function. Prolongation of QTcd has been associated with cardiovascular morbidity and mortality. We compared the effects of high-pressure (15 mmHg) and low-pressure (7 mmHg) CO2 pneumoperitoneums On the QT interval, the rate-corrected QT interval (QTc), the QT dispersion (QTd), and the corrected QT dispersion (QTcd) during laparoscopic cholecystectomy.Methods Twenty consecutive patients were in a low-pressure pneumoperitoneum group and 32 were in a high-pressure pneumoperitoneum group. A 12-lead electrocardiogram was used to monitor cardiac variables. In all patients, serial electrocardiograms were recorded before anesthesia induction (baseline), immediately after the pneumoperitoneum had been created, every 15 minutes during CO2 insufflation, and 5 minutes after deflation. Two observers measured the QT intervals independently, and the QTcd was calculated using Bazett's formula.Results The QT interval and the QTc interval did not change significantly during the Study in either group. The QTd and QTcd in the high-pressure pneumoperitoneum group increased significantly during CO2 insufflation and were significantly higher in the high-pressure pneumoperitoneum group compared with the low-pressure pneumoperitoneum group. Changes Caused by CO2 insufflation were reversible.Conclusions Statistically significant increases of QTd and QTcd, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO2 insufflation in both high-pressure and low-pressure pneumoperitoneums. QTd and QTcd were significantly higher in the high-pressure pneumoperitoneum group than they were in the low-pressure pneumoperitoneum group. QT interval changes were not related to anesthetic agents, Surgical stress, hypercapnia, or 41 duration of CO2 insufflation. Increased intra-abdominal pressure may have caused these changes.