EFFECTOR OF HEMODYNAMICS DURING LAPAROSCOPY - CO2 ABSORPTION OR INTRAABDOMINAL PRESSURE
EFFECTOR OF HEMODYNAMICS DURING LAPAROSCOPY - CO2 ABSORPTION OR INTRAABDOMINAL PRESSURE
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DOI：
10.1006/jsre.1995.1198
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发表时间：
1995-10-01
影响因子：
2.2
通讯作者：
WOLFE, BM
中科院分区：
文献类型：
--
作者：
HO, HS;SAUNDERS, CJ;WOLFE, BM
关于腹腔内压力和全身二氧化碳积累对腹腔镜血流动力学的影响一直存在争议。在一项随机的CO2和氮气交叉研究中，我们比较了气腹期间的酸碱和血流动力学变化，以检验腹腔镜期间吸收的CO2而不是产生的15mmhg腹腔内压力导致这些变化的假设。对8头成年猪进行麻醉，采用固定分钟通气。利用代谢测量车对过期血流进行分析，测定代谢功能。基线期结束后，将动物随机分为两组，分别在15 mmHg腹内压下进行2小时CO2或氮气气腹，然后进行1小时恢复。在至少48小时的恢复期后，用其他气体重复实验。代谢数据显示，在CO2气腹期间，腹膜上皮对CO2气体有显著的吸收。吸入二氧化碳气体的动物肺部二氧化碳排出量增加75%，伴有明显的酸血症和高碳酸血症，而吸入氮气的动物没有酸碱干扰。两组的耗氧量基本保持不变，甚至在气腹期间也是如此。CO2气腹也与全身性和肺动脉高压有关，并可使脑卒中容量减少15%。单独气腹不影响血流动力学。在腹腔镜检查中使用CO2气体气腹导致全身的CO2通过腹膜吸收。这导致酸血症、呼吸急促和血流动力学下降。在实验模型中，腹腔镜手术中常规使用的腹内压不影响代谢功能、酸碱平衡或血流动力学。(C) 1995学术出版社，Inc。
Controversy has been raised about the effects of systemic carbon dioxide accumulation versus the intra-abdominal pressure on hemodynamics during laparoscopy. We compared the acid-base and hemodynamic changes during pneumoperitoneum in a randomized cross-over study between CO2 and nitrogen gases to test the hypothesis that the CO2 absorbed during laparoscopy, rather than the 15 mmHg intra-abdominal pressure created, accounted for these changes. Eight adult pigs were anesthetized and ventilated with a fixed minute ventilation. Metabolic function was measured from analysis of expired flow by a metabolic measurement cart. After baseline periods, animals were randomized into two groups, for 2 hr of either CO2 or nitrogen pneumoperitoneum at 15 mmHg intra-abdominal pressure, followed by 1 hr of recovery. After at least a 48-hr recovery period, the experiment was repeated with the other gas. Metabolic data revealed that there was a significant absorption of CO2 gas across the peritoneal epithelium during CO2 pneumoperitoneum. Animals insufflated with CO2 gas experienced a 75% increase in pulmonary CO2 excretion, with significant acidemia and hypercapnia, whereas there were no acid-base disturbances in those with nitrogen insufflation. Oxygen consumption remained essentially unchanged in both groups, even during pneumoperitoneum. CO2 pneumoperitoneum was also associated with systemic and pulmonary arterial hypertension and a reduction in stroke volume of up to 15%. Pneumoperitoneum alone did not compromise hemodynamics. Pneumoperitoneum using CO2 gas during laparoscopy resulted in systemic CO2 absorption across the peritoneum. This led to acidemia, hypercapnea, and depressed hemodynamics. The intra-abdominal pressure routinely used during laparoscopic surgery did not affect metabolic function, acid-base balance, or hemodynamics in the experimental model. (C) 1995 Academic Press, Inc.