腹膜前二氧化碳气腹对猪心肺功能的影响。

The effects of preperitoneal carbon dioxide insufflation on cardiopulmonary function in pigs.

作者信息

Blaney M W, Calton W C, North J H

机构信息

Department of Surgery, Dwight David Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA.

出版信息

JSLS. 1999 Jan-Mar;3(1):49-55.

PMID:10323170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3015344/

Abstract

BACKGROUND AND OBJECTIVES

Although considerable experimental and clinical knowledge exists on the physiology of pneumoperitoneum, insufflation of the preperitoneal space has not been extensively studied. The purpose of this study is to evaluate the physiology associated with preperitoneal carbon dioxide (CO2) insufflation in a porcine model.

METHODS

Eleven pigs weighing 35 to 45 kg were anesthetized and placed on mechanical ventilation. A pulmonary artery catheter and an arterial line were inserted. Balloon dissection of the preperitoneal space and insufflation to 10 mm Hg for 1.5 hours, followed by an increase to 15 mm Hg for an additional 1.5 hours, was performed. Hemodynamic and arterial blood gas values were determined every 15 minutes throughout the stabilization and three-hour insufflation period. Hemodynamic parameters and blood gas values were analyzed using one-way analysis of variance with respect to insufflation time and pressure.

RESULTS

Analysis of hemodynamics (CO, CVP, PAD, PAS, PCWP) did not demonstrate statistical significance with respect to time. However, there was a statistical difference in CO (p=.01), CVP (p<.01), and PCWP (p=.034) when comparing a pressure of 15 mm Hg to a pressure of 10 or 0 mm Hg. The other parameters did not demonstrate significant differences among the three pressure groups. Arterial PCO2 and pH were highly significant with respect to time (p<.01 and P<.01, respectively) and among the pressure groups (p<.01 and P<.01, respectively).

CONCLUSIONS

Insufflation of the preperitoneal space with CO2 gas does not cause significant alterations in hemodynamics and blood gas changes at a pressure of 10 mm Hg. However, when a pressure of 15 mm Hg is used to insufflate this space, there is evidence of decreased pH and cardiac output, with elevated CVP and CO2 retention. This correlates with greater pneumodissection of the gas within the layers of the abdominal wall when elevated pressures are used.

摘要

背景与目的

尽管关于气腹生理已有大量实验和临床知识，但腹膜前间隙充气尚未得到广泛研究。本研究的目的是评估猪模型中腹膜前二氧化碳（CO₂）充气相关的生理情况。

方法

对11头体重35至45千克的猪进行麻醉并实施机械通气。插入肺动脉导管和动脉导管。进行腹膜前间隙的球囊分离，并充气至10毫米汞柱持续1.5小时，随后增加至15毫米汞柱再持续1.5小时。在整个稳定期和三小时充气期，每15分钟测定血流动力学和动脉血气值。使用单因素方差分析对充气时间和压力进行血流动力学参数和血气值分析。

结果

血流动力学分析（CO、CVP、PAD、PAS、PCWP）在时间方面未显示统计学意义。然而，将15毫米汞柱的压力与10或0毫米汞柱的压力进行比较时，CO（p = 0.01）、CVP（p < 0.01）和PCWP（p = 0.034）存在统计学差异。其他参数在三个压力组之间未显示显著差异。动脉PCO₂和pH在时间方面（分别为p < 0.01和P < 0.01）以及压力组之间（分别为p < 0.01和P < 0.01）具有高度显著性。