A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow
A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow
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DOI：
10.1097/01.sla.0000153034.54128.5e
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发表时间：
2005-02-01
影响因子：
9
通讯作者：
Reynolds, JD
中科院分区：
文献类型：
--
作者：
Ali, NA;Eubanks, WS;Reynolds, JD
目的：探讨加入亚硝酸乙酯（ENO）增加一氧化氮生物活性是否能减轻气腹引起的内脏灌注减少。背景资料：气腹期间器官血流量减少，可能导致腹腔镜相关的发病率和死亡率。以前控制流量减少的尝试都是无效的。方法：将激光多普勒血流探头置于麻醉猪的肝脏和右肾上。在基线记录期后，向动物充气至最终腹腔内压力为15转汞柱。第一组接受CO2（标准做法），而第二组接受CO2加100 ppm ENO。保持充气60分钟，然后手动放腹；监测又持续了60分钟。结果：CO2注入（n = 5）使肝脏血流量减少一半，在注入后的整个过程中肝脏血流量保持在这个水平。加入100ppm ENO （n = 6）可减轻急性和延长血流量的减少。数据统计建模结果显示，与CO2组相比，ENO组猪肝脏血流量平均增加14.3 U/min （P = 0.0454）。相比之下，两种治疗方法均未显著改变肾血流量（P = 0.6215）。结论：ENO能有效减轻气腹所致的腹腔内血流量减少。结果提出了一种新的治疗方法，在腹腔镜手术过程中调节血流动力学的变化。
Objective: To determine if increasing nitric oxide bioactivity by inclusion of ethyl nitrite (ENO) in the insufflation admixture would attenuate pneumoperitoneum-induced decreases in splanchnic perfusion.Summary Background Data: Organ blood flow is reduced during pneumoperitoneum and can contribute to laparoscopy-associated morbidity and mortality. Previous attempts to control such decreases in flow have been ineffective.Methods: Laser-Doppler flow probes were placed on the liver and right kidney of anesthetized pigs. After a baseline recording period, animals were insufflated to a final intraperitoneal pressure of 15 turn Hg. Group one received CO2 (standard practice), whereas group 2 received CO2 plus 100 ppm ENO. Insufflation was maintained for 60 minutes and then the abdomen was manually deflated; monitoring was continued for another 60 minutes.Results: CO2 insufflation (n = 5) cut liver blood flow in half, liver flow remained at this level throughout the postinsufflation period. Inclusion of 100 ppm ENO (n = 6) attenuated both the acute and prolonged blood flow decreases. Statistical modeling of the data showed that, on average, liver blood flow was 14.3 U/min higher in the ENO pigs compared with the CO2 group (P = 0.0454). In contrast, neither treatment significantly altered kidney blood flow (P = 0.6215).Conclusion: The data indicate that ENO can effectively attenuate pneumoperitoneum-induced blood flow decreases within the peritoneal cavity. The result suggests a novel therapeutic method of regulating hemodynamic changes during laparoscopic procedures.