Wpływ zmiany pozycji chorego na wartość wybranych parametrów hemodynamicznych

*Magdalena A. Wujtewicz, Radosław Owczuk, Anna Wądrzyk, Wiktor Szymanowicz, Maria Wujtewicz

Summary
Background.The effects of body position on haemodynamics have usually been investigated in healthy people. We hypothesized that these effects may be different in patients with lung tumours, scheduled for thoracotomy.
Methods. 100 adult patients, of both sexes, and aged 21-81 years were enrolled in the study. Mean arterial pressure (MAP), heart rate (HR), non-invasive cardiac output (NICO) cardiac index (CI), and stroke volume index (SVI) were noted: 1. Immediately after tracheal intubation in the supine position, 2. Immediately after turning to the right lateral (group I) or left lateral (group II) position and 3. 10 minutes later, before incision of the skin. Anaesthesia was induced with fentanyl, etomidate and vecuronium in typical doses and maintained with N₂O/O₂ mixture.
Results. MAP decreased significantly in both groups after positioning. HR was lower in group II (left lateral position) than in group I. MAP, noted before skin incision was lower in group II, compared with group I. In group I, CI and SVI decreased significantly immediately after positioning. SVI returned to normal values after 10 minutes, however CI was significantly increased compared to baseline values. In group II, CI and SVI decreased insignificantly immediately after positioning. After 10 minutes CI returned to normal, while SVI increased significantly compared to baseline values. There were no significant differences in CI and SVI between the groups.
Conclusions. Both lateral positions caused transient hypotension but cardiac output decreased only in the right lateral position. The mechanism of this phenomenon is not clear, however it may be caused by decrease of the right ventricular end-diastolic pressure in haemodynamically unstable patients.

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