Greif W M, Forse R A
Harvard Center for Minimally Invasive Surgery and the Department of Surgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts 02215, USA.
Am J Surg. 1999 Mar;177(3):216-21. doi: 10.1016/s0002-9610(99)00013-6.
Increasingly, laparoscopy is being used in critically ill patients in whom there is a question of intra-abdominal sepsis. We examine the cardiopulmonary effects of laparoscopy in a porcine model of adult respiratory distress syndrome (ARDS).
Domestic pigs (n = 12) underwent saline lung lavage and subsequent surgical abdominal exploration using either laparoscopy or conventional laparotomy. Hemodynamic and respiratory measurements were obtained.
After pulmonary lavage, the two groups developed similarly diminished arterial pO2 (P <0.001), a worsened pulmonary shunt (P <0.001), and an increased alveolar-arterial oxygen gradient (P <0.001). The pulmonary compliance was significantly decreased in the animals undergoing laparoscopy (versus laparotomy, P <0.05). The mean pulmonary arterial pressure did not differ between the groups. The laparoscopic group had a higher pCO2 (not significant) and was more acidotic (P <0.05) than the laparotomy group. The laparoscopic animals had an increased heart rate (P <0.05), cardiac index (P <0.01), and oxygen delivery (P <0.005) as compared with the laparotomy group.
During laparoscopy, animals with ARDS demonstrate further compromise in pulmonary physiologic parameters but overall cardio-respiratory function is preserved.
越来越多地，腹腔镜检查被用于患有腹腔内感染问题的重症患者。我们在成人呼吸窘迫综合征（ARDS）猪模型中研究腹腔镜检查对心肺的影响。
家猪（n = 12）接受盐水肺灌洗，随后使用腹腔镜检查或传统剖腹术进行腹部手术探查。获取血流动力学和呼吸测量数据。
肺灌洗后，两组动脉血氧分压均同样降低（P <0.001），肺分流恶化（P <0.001），肺泡 - 动脉氧梯度增加（P <0.001）。接受腹腔镜检查的动物肺顺应性显著降低（与剖腹术相比，P <0.05）。两组之间平均肺动脉压无差异。腹腔镜检查组二氧化碳分压较高（无统计学意义），且比剖腹术组更酸中毒（P <0.05）。与剖腹术组相比，接受腹腔镜检查的动物心率增加（P <0.05）、心脏指数增加（P <0.01）、氧输送增加（P <0.005）。
在腹腔镜检查期间，患有ARDS的动物肺生理参数进一步受损，但整体心肺功能得以保留。
