The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study
The effects of CO2-insufflation with 5 and 10 mmHg during thoracoscopy on cerebral oxygenation and hemodynamics in piglets: an animal experimental study
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DOI：
10.1007/s00464-014-4009-5
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发表时间：
2015-09-01
影响因子：
3.1
通讯作者：
van der Zee, David C.
中科院分区：
文献类型：
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作者：
Stolwijk, Lisanne J.;Tytgat, Stefaan H. A. J.;van der Zee, David C.
为评价CO2气腹对新生儿脑氧合和血流动力学的影响，采用微创技术对新生儿进行外科治疗的比例越来越高。最近，对于在胸腔镜术中吸入二氧化碳会导致新生儿脑氧合下降的问题引起了关注。这是一项动物实验研究。对仔猪进行麻醉、插管、通风和外科手术准备，以便进行二氧化碳气腹。监测动脉血氧饱和度(SaO2)、心率(HR)、平均动脉压(MABP)和脑氧分压(RScO2)。计算脑氧摄取的估计值CFTOE(SaO(2)-rScO(2))/SaO(2)。每隔15‘：注气前(T0)、注气后(T1-T4)和注气后(T5)抽取动脉血气，随机分为5组(P5)和10组(P10)。两只P10仔猪在气腹后需要复苏，没有一只P5。PaCO(2)、pH和SaO(2)的线性混合效应模型显示，这些值依赖于时间和时间的平方(p<；0.001)，但在5和10毫米汞组之间没有差异。分析表明，随着时间的推移，5和10毫米汞组的心率和平均动脉压有显著变化，10毫米汞组的心率和血压显著较高(p<；0.001)。对于rScO(2)和cFTOE，没有组间差异，但存在显著的时间效应：rScO(2)增加，cFTOE减少(p<；0.001)。胸腔镜术中注入二氧化碳10毫米汞柱会引起更严重的血流动力学不稳定，似乎与脑血流灌注量减少有关，表现为较高的氧摄取量。胸腔镜术中注入5毫米汞柱的二氧化碳对脑氧合无不良影响。
To evaluate the effect of CO2-insufflation with 5 and 10 mmHg on cerebral oxygenation and hemodynamics in neonates.An increasing percentage of surgical interventions in neonates are performed by minimal invasive techniques. Recently, concerns have been raised regarding a decrease of cerebral oxygenation in neonates during thoracoscopy as a result of CO2-insufflation.This was an animal experimental study. Piglets were anesthetized, intubated, ventilated, and surgically prepared for CO2-insufflation. Insufflation was done with 5 or 10 mmHg CO2 during 1 h. Arterial saturation (SaO(2)), heart rate (HR), mean arterial blood pressure (MABP), and cerebral oxygenation (rScO(2)) were monitored. CFTOE, an estimator of cerebral oxygen extraction ((SaO(2) - rScO(2))/SaO(2))), was calculated. Arterial blood gases were drawn every 15': pre (T0), during (T1-T4) and after CO2-insufflation (T5).Ten piglets (4 kg) were randomized for 5 (P5) and 10 (P10) mmHg CO2-insufflation. Two P10 piglets needed resuscitation after insufflation, none P5. Linear mixed-effect modeling of paCO(2), pH, and SaO(2) showed that values were dependent on time and time squared (p < 0.001) but were not different between the 5 and 10 mmHg groups. Analysis demonstrated significant changes over time in heart rate and MABP between the 5 and 10 mmHg groups, with a significant higher heart rate and lower blood pressure in the 10 mmHg group (p < 0.001). For rScO(2) and cFTOE, no group differences could be demonstrated, but a significant effect of time was found: rScO(2) increased and cFTOE decreased (p < 0.001).Insufflation of CO2 during thoracoscopy with 10 mmHg caused more severe hemodynamic instability and seems to be related with a decrease of cerebral perfusion as represented by a higher oxygen extraction. CO2-insufflation of 5 mmHg for thoracoscopy seems to have no adverse effects on cerebral oxygenation.