대한간호학회지 (Journal of Korean Academy of Nursing)

한국간호과학회 (Korean Society of Nursing Science)
권호 표지
DOI QR코드

DOI QR Code

복강경 대장절제술에서 기복이 고혈압 환자의 심박수, 평균동맥압 및 심박출량에 미치는 영향

The Effects of Pneumoperitoneum on Heart Rate, Mean Arterial Blood Pressure and Cardiac Output of Hypertensive Patients during Laparoscopic Colectomy

  • Kim, Eun-Ju (Department of Nursing, National Cancer Center) ;
  • Yoon, Hae-Sang (Department of Nursing, Gachon University of Medicine & Science)
  • 투고 : 2009.12.07
  • 심사 : 2010.06.15
  • 발행 : 2010.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: This study was performed to identify effects of pneumoperitoneum on hemodynamic changes of hypertensive patients undergoing laparoscopic colectomy under general anesthesia. Methods: Data collection was done from January 2 to June 10, 2008. Seventy-six patients, including 38 hypertensive patients, who had taken antihypertensive drugs more than 1 month and 38 normotensive patients undergoing laparoscopic colectomy were enrolled in this study. The hemodynamic parameters were heart rate (HR), mean arterial pressure (MAP) and cardiac output (CO) which were measured 7 times from before induction of anesthesia to 5 min after deflation of the pneumoperitoneum. Collected data were analyzed using Repeated Measures ANOVA and Bonferroni comparison method. Results: HR in the hypertensive group was significantly decreased at deflation of the pneumoperitoneum and 5 min after deflation of the pneumoperitoneum (p=.012). MAP in the hypertensive group was not different from the normotensive group (p=.756). CO in hypertensive group was significantly lower than normotensive group (p<.001) from immediately after pneumoperitoneum to 5 min after deflation of the pneumoperitoneum. Conclusion: The results indicate that pneumoperitoneum during laparoscopic surgery does not lead to clinically negative hemodynamic changes in heart rate, mean arterial pressure or cardiac output of hypertensive patients, who have taken antihypertensive drugs for more than 1 month.

키워드

참고문헌

  1. Alfonsi, P., Vieillard-Baron, A., Coggia, M., Guignard, B., Goeau- Brissonniere, O., Jardin, F., et al. (2006). Cardiac function during intraperitoneal $Co_{2}$ insufflation for aortic surgery: A transesophageal echocardiographic study. Anesthesia and Analgesia, 102, 1304-1310. https://doi.org/10.1213/01.ane.0000202473.17453.79
  2. Artuso, D., Wayne, M., Cassaro, S., Cerabona, T., Teixeira, J., & Grossi, R. (2005). Hemodynamic changes during laparoscopic gastric bypass procedure. Archives of surgery, 140, 289-292. https://doi.org/10.1001/archsurg.140.3.289
  3. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L. Jr., et al. (2003). The seventh report of the joint national committee on prevention, detection, ealuation, and treatment of high blood pressure: The JNC 7 report. The Journal of the American Medical Association, 289, 2560-2572. https://doi.org/10.1001/jama.289.19.2560
  4. Coste, C., Guignard, B., Menigaux, C., & Chauvin, M. (2000). Nitrous oxide prevents movement during orotracheal intubation without affecting BIS value. Anesthesia and Analgesia, 91, 130-135.
  5. Fang, F., Guo, T. Z., Davies, M. F., & Maze, M. (1997). Opiate receptors in the periaqueductal gray mediate analgesic effect of nitrous oxide in rats. European Journal of Pharmacology, 336, 137-141. https://doi.org/10.1016/S0014-2999(97)01219-3
  6. Gerges, F. J., Kanazi, G. E., & Jabbour-Khoury, S. I. (2006). Anesthesia for laparoscopy: A review. Journal of Clinical Anesthesia, 18, 67-78. https://doi.org/10.1016/j.jclinane.2005.01.013
  7. Hein, H. A., Joshi, G. P., Ramsay, M. A., Fox, L. G., Gawey, B. J., Hellman, C. L., et al. (1997). Hemodynamic changes during laparoscopic cholecystectomy in patients with severe cardiac disease. Journal of Clinical Anesthesia, 9, 261-265. https://doi.org/10.1016/S0952-8180(97)00001-9
  8. Henny, C. P., & Hofland, J. (2005). Laparoscopic surgery: Pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surgical Endoscopy, 19, 1163-1171. https://doi.org/10.1007/s00464-004-2250-z
  9. Ishizuka, B., Kudo, Y., Amemiya, A., Tanii, M., & Aoki, T. (2000). Plasma catecholamine responses during laparoscopic gynecologic surgery with $Co_{2}$ insufflation. The Journal of the American Association of Gynecologic Laparoscopists, 7, 37-43. https://doi.org/10.1016/S1074-3804(00)80007-9
  10. Itoh, H., Takeda, K., Nakamura, K., Fujita, H., Uchida, A., Kuwahara, T., et al. (1995). Young borderline hypertensives are hyperreactive to mental arithmetic stress: Spectral analysis of R-R intervals. Journal of the Autonomic Nervous System, 54, 155-162. https://doi.org/10.1016/0165-1838(95)00008-L
  11. Joris, J. L., Hamoir, E. E., Hartstein, G. M., Meurisse, M. R., Hubert, B. M., Charlier, C. J., et al. (1999). Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesthesia and Analgesia, 88, 16-21.
  12. Kang, H., Lee, I. G., Cho, C. K., Baek, C. H., Park, J. W., Jung, Y. H., et al. (2005). The effects of alfentanil and a combination of alfentanil and esmolol on hemodynamic responses after endotracheal intubation in hypertensive patients. Korean Journal of Anesthesiology, 49, 136-141.
  13. Kang, Y. W., Yoon, S. G., Kim, E. G., Lee, C. M., & Kim, K. Y. (2007). Comparison of laparoscopic with open resections in colorectal cancer: Analysis of short-term results. Journal of Korean Society Coloproctology, 23, 93-100. https://doi.org/10.3393/jksc.2007.23.2.93
  14. Kim, E. A., Lee, J. W., Lim, H. S., Son, J. S., & Ko, S. H. (2007). Desflurane-induced hemodynamic changes in patients with hypertension. Korean Journal of Anesthesiology, 52, 516-520. https://doi.org/10.4097/kjae.2007.52.5.516
  15. Korean Accreditation Board of Nursing. (2007, March). Workshop for Education and Examination of Advanced Practice Nurse. Seoul, Korea.
  16. Lacy, A. M., García-Valdecasas, J. C., Delgado, S., Castells, A., Taurá, P., Piqué, J. M., et al. (2002). Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: A randomised trial. Lancet, 359, 2224-2229. https://doi.org/10.1016/S0140-6736(02)09290-5
  17. Lee, S. (2004). Cardiac output measurement. Korean Journal of Anesthesiology, 46, 1-9.
  18. Lee, Y. J., & Lee, J. U. (2006). Hemodynamic changes during the use of different general anesthetic methods in laparoscopic gynecologic surgery. Korean Journal of Anesthesiology, 51, 139-146.
  19. Marik, P. E., & Varon, J. (2007). Hypertensive crises: Challenges and management. Chest, 131, 1949-1962. https://doi.org/10.1378/chest.06-2490
  20. Meininger, D., Westphal, K., Bremerich, D. H., Runkel, H., Probst, M., Zwissler, B., et al. (2008). Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy. World Journal of Surgery, 32, 1400-1405. https://doi.org/10.1007/s00268-007-9424-5
  21. Nishikawa, T., & Naito, H. (1996). Clonidine modulation of hemodynamic and catecholamine responses associated with hypoxia or hypercapnia in dogs. Anesthesiology, 84, 672-685. https://doi.org/10.1097/00000542-199603000-00023
  22. Noh, G. J., Cho, S. Y., Yeom, J. H., Shin, W. J., Kim, Y. C., Lee, D. H., et al. (2000). Cardiovascular and respiratory system monitoring in laparoscopic cholecystectomy. Korean Journal of Anesthesiology, 39, 303-308.
  23. Park, S. W., Baek, W. Y., Hong, J. G., Park, J. W., & Kim, B. K. (1990). Changes of blood pressure and heart rate during anesthesia of hypertensive patients according to antihypertensive medication. Korean Journal of Anesthesiology, 23, 470-475.
  24. Piccirillo, G., Bucca, C., Durante, M., Santagada, E., Munizzi, M. R., Cacciafesta, M., et al. (1996). Heart rate and blood pressure variabilities in salt-sensitive hypertension. Hypertension, 28, 944-952. https://doi.org/10.1161/01.HYP.28.6.944
  25. Pierson, R. J., & McSwiney, M. M. (2008). Hypertension and general anaesthesia: Guidance for general practitioners and results of a questionnaire. Anaesthesia, 63, 439-441.
  26. Rist, M., Hemmerling, T. M., Rauh, R., Siebzehnrubl, E., & Jacobi, K. E. (2001). Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen. Journal of Clinical Anesthesia, 13, 244-249. https://doi.org/10.1016/S0952-8180(01)00242-2
  27. Sood, J., Jayaraman, L., Kumra, V. P., & Chowbey, P. K. (2006). Laparoscopic approach to pheochromocytoma: Is a lower intraabdominal pressure helpful? Anesthesia and Analgesia, 102, 637-641. https://doi.org/10.1213/01.ane.0000184816.00346.65
  28. Yoon, H. J., & Oh, J. I. (2005). Correlations between mean arterial blood pressure, cardiac index, and systemic vascular resistance index in laparoscopically-assisted vaginal hysterectomy (LAVH). Korean Journal of Anesthesiology, 48, 45-49.