长时间气腹合并头高位对行机器人胃切除术患者术中心率校正QT间期的影响：一项观察性研究
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Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy:an observational study
背景与目的
有文献表明，气腹和头高位可刺激交感神经系统，增加心律失常的发生风险。我们观察了长时间气腹合并头高位对行机器人胃切除术患者术中心率校正的QT（QTc）间期的影响。
方 法
这项前瞻性观察性研究共纳入28名行机器人胃切除术的患者。记录以下时点的QTc间期：麻醉诱导前（基础值）; 气管插管后10分钟; 建立气腹并头高位后1分钟，5分钟，30分钟，60分钟和90分钟; 仰卧位关闭气腹后; 手术结束时。主要结局指标是气腹合并头高位后90分钟的QTc间期。
结 果
与基础值比较，QTc间期在气腹后1分钟及60分钟显著延长，在90分钟达到峰值，持续并显著延长直至手术结束。然而血流动力学没有发生较大的变化。
结 论
长时间二氧化碳气腹合并头高位可显著延长行机器人胃切除术患者术中的QTc间期。 因此，对易发生室性心律失常的患者需要密切关注及监测。
原始文献摘要
Kim NY1, Bai SJ1, Kim HI2, Hong JH3, Nam HJ1, Koh JC4, Kim HJ1.
J Int Med Res. 2018 Jan 1:300060518786914. doi: 10.1177/0300060518786914. [Epub ahead of print]
Effects of long periods of pneumoperitoneum combined with the head-up
position on heart rate-corrected QT interval during robotic gastrectomy:an observational study.
Abstract
Objective: Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.
Methods: This prospective observational study involved 28 patients undergoing robotic gastrectomy.The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.
Results: Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.
Conclusion: A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia.
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