Baird J E, Granger R, Klein R, Warriner C B, Phang P T
Department of Surgery, St. Paul's Hospital Pulmonary Research Laboratory, and University of British Columbia, Vancouver, Canada.
Am J Surg. 1999 Feb;177(2):164-6. doi: 10.1016/s0002-9610(98)00326-2.
Laparoscopic techniques are being increasingly used for retroperitoneal surgery. However, hemodynamic and ventilatory efforts of retroperitoneal carbon dioxide (CO2) insufflation have not been studied. We hypothesized that differences in absorptive surface, anatomy, and compartment compliance could result in different hemodynamic and ventilatory effects between retroperitoneal and intraperitoneal insufflation.
Pigs (n = 7) were anesthetized and stabilized. The peritoneal cavity was incrementally insufflated with CO2 to a maximum pressure of 25 cm H2O and the gas released. Hemodynamics and arterial blood gas values were recorded initially, at each level of insufflation, and following the pneumoperitoneum release until baseline values were reached. This insufflation protocol was repeated in the retroperitoneum.
Mean arterial pressure (111 mm Hg, 95% confidence interval 99 to 156) and cardiac output (3.7 L/min, 2.8 to 5.2) did not change with increasing insufflation pressure of either intraperitoneum or retroperitoneum. PaCO2 was directly related to insufflation pressure in both spaces, increasing from 41.2 mm Hg (37.3 to 43.4) at baseline to 57.7 mm Hg (47.6 to 82.1) at insufflation pressure of 25 cm H2O. After release of the insufflation gas, time to return to baseline PaCO2 was slightly less from the retroperitoneal space (73 minutes, 45 to 105) than the intraperitoneal (107 minutes, 35 to 175).
The effects of CO2 insufflation on hemodynamics and PaCO2 are the same in the retroperitoneal and intraperitoneal spaces.
腹腔镜技术在腹膜后手术中的应用越来越广泛。然而，腹膜后二氧化碳（CO₂）气腹对血流动力学和通气的影响尚未得到研究。我们推测，吸收表面积、解剖结构和腔室顺应性的差异可能导致腹膜后气腹和腹腔内气腹产生不同的血流动力学和通气效果。
对7头猪进行麻醉并使其状态稳定。向腹腔内逐步注入CO₂，使最大压力达到25 cm H₂O，然后释放气体。在最初、每次注气时以及气腹解除后直至达到基线值期间，记录血流动力学和动脉血气值。在腹膜后重复此注气方案。
无论是腹腔内还是腹膜后注气压力增加，平均动脉压（111 mmHg，95%置信区间99至156）和心输出量（3.7 L/min，2.8至5.2）均未改变。在两个腔隙中，PaCO₂均与注气压力直接相关，从基线时的41.2 mmHg（37.3至43.4）增加到25 cm H₂O注气压力时的57.7 mmHg（47.6至82.1）。注气气体释放后，腹膜后间隙恢复到基线PaCO₂的时间（73分钟，45至105）略短于腹腔内（107分钟，35至175）。
CO₂气腹对腹膜后和腹腔内间隙血流动力学和PaCO₂的影响相同。
