Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison
Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison
复制标题
DOI：
10.1089/end.2022.0233
复制
发表时间：
2022-12-06
影响因子：
2.7
通讯作者：
Ma, Xin
中科院分区：
文献类型：
--
作者：
Peng, Cheng;Shen, Hao;Ma, Xin
目的：评价经腹膜或后腹膜腹腔镜手术期间CO2气腹对静脉血流动力学和心肺功能的影响。材料和方法：单机构前瞻性研究。纳入了 43 名接受腹膜后 (22) 或经腹膜 (21) 腹腔镜肾部分切除术的肾细胞癌患者。通过微创FloTrac/Vigileo系统监测血流动力学功能。使用经食管超声心动图测量下腔静脉（IVC）的直径和血流量。在基线、吹气至 14 mm Hg 后 10、30、60 分钟以及排气后 10 分钟记录测量参数。 结果：对于经腹膜腹腔镜手术 (TPL) 和后腹膜腹腔镜手术 (RPL) 中的血流动力学变化，经腹膜 CO2 吹入导致中心静脉压 (CVP)、气道峰值压力快速平行增加(AWP) 和气腹后第一个 30 分钟的 IVC 血流速度 (p < 0.05)。相反，RPL 中 CVP、AWP 和 IVC 血流速度逐渐增加。这些参数的变化显着低于 TRL（p < 0.001；p = 0.002；p = 0.004）。两组的平均最大 CVP 分别为 20 和 16 毫米汞柱。吹气 10 分钟后，TPL 中腔房交界处的 IVC 直径显着减小，但在整个手术过程中 RPL 中 IVC 直径保持不变。心肺功能变化方面，短时间气腹后心输出量下降，但两组间无统计学差异。 RPL中动脉二氧化碳分压和呼气末二氧化碳张力的增量显着高于TPL（p < 0.001；p < 0.001）。结论：与腹膜后气腹相比，经腹膜气腹对IVC血流动力学有显着影响。腹内压（IAP）升高导致AWP和静脉回流阻力升高，从而导致经腹膜入路时CVP显着增加。调整IAP和CVP之间的平衡可能是控制静脉出血的有效方法。
Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery.Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation.Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001).Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding.