| Background and purposeIn recent years,total laparoscopic hysterectomy is widely used in clinical practice.Compared with traditional surgery,total laparoscopic hysterectomy has less damage,can reduce tissue inflammatory response and shorten postoperative recovery time.There are often different degrees of anemia before gynecological operation.Studies have shown that preoperative anemia is associated with postoperative complications and mortality.On the one hand,total laparoscopic hysterectomy needs carbon dioxide pneumoperitoneum and Trendelenburg position,which will affect the hemodynamics of patients during operation;on the other hand,anemia patients may have insufficient tissue oxygen supply,and organ system compensation ability will also affect the hemodynamic stability of patients.According to the regulation mechanism of blood flow redistribution of human body,when the output of heart is reduced,the blood flow of brain,heart,kidney and other important organs is guaranteed preferentially,while the skin,skeletal muscle and other organs may be seriously affected.Monitoring the muscle tissue oxygen saturation may find out the lack of oxygen supply,and then provide the basis for clinical decision-making.The effect of anemia on oxygen saturation of muscle tissue during laparoscopic hysterectomy has not been reported.The purpose of this study was to observe the effects of anemia on hemodynamics,muscle tissue oxygen and vasoactive drugs usage in patients with total laparoscopic hysterectomy,and on postoperative recovery.Objects and methodsSixty female patients undergoing total laparoscopic hysterectomy,aged 18 to 65 and ASA grade ? to ? were included in this study.Due to the concentration of Hb before operation,the patients were divided into three groups:moderate anemia group(group A:n=20 60?HB<90g/L),mild anemia group(group B:n=2090?HB<120g/L),normal hemoglobin group(Group C:n=20 Hb?120g/L).After entering the room,routine monitoring was performed.The heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),cardiac index(CI)were continuously monitored by LiDCOrapid system.At the same time monitoring the forearm muscle tissue oxygen saturation(SamtO2)and the flank muscle tissue oxygen saturation(SfintO2).Hemodynamic indexes including HR,MAP,CO,CI and SamtO2,SfmtO2 were recorded at baseline(T1),before intubation(T2),30 min after Trendelenburg position(T3),1 h after Trendelenburg position(T4)and 5 minutes after operation(T5).The use of vasoactive drugs during operation,total fluid volume,blood loss,urine volume,24 hours Qor-15 scale scores,postoperative nausea and vomiting(PONV),postoperative complications were recorded.ResultsThere was no significant difference in age,height,weight,total fluid volume,blood loss,urine volume,operation time and remifentanil dosage between the three groups(P>0.05).The difference of Hb and Hct between the three groups was statistically significant(P<0.05);compared with group C,the dosage of propofol in group A was smaller during the maintenance period(P<0.05);in group A,CO and CI were significantly lower at T2,T4 and T5(P<0.05);MAP in group A was significantly lower at T1 and T5(P<0.05);in group B,map at T2 and T5 was significantly lower(P<0.05).Compared with T1 time,CO in T2 and T3 of the three groups decreased significantly(P<0.05),and group A at T4,T5 decreased significantly(P<0.05);at T2-T4 time,CI of patients in group A and group B decreased significantly(P<0.05);at the time of T2-Ts,MAP in the three groups,and HR in group A and group B decreased significantly(P<0.05);HR of patients in group C decreased significantly at T2-T4(P<0.05).At T2 and T5,CO and CI were positively correlated with Hb(P<0.05).The frequency of using vasoactive drugs in group A was significantly higher than that in group C(P<0.05).There was no significant difference between SamtO2 and SfmtO2 in the three groups(P>0.05).There was no significant difference in qor-15 score,nausea and vomiting within 24 hours,VAS score of the most severe degree of pain,the first time to walk out of bed,the first time to tolerate diet,the time to stay in hospital and the incidence of postoperative complications among the three groups(P>0.05).Conclusion1.Compared with the patients with normal hemoglobin,the hemodynamics of the patients with moderate anemia fluctuated greatly during the operation,the usage rate of vasoactive drugs was high,and the dosage of propofol in the maintenance stage was less2.Compared with normal hemoglobin patients,mild and moderate anemia had no significant effect on the oxygen saturation of muscle tissue during laparoscopic hysterectomy... |
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