Loeckinger A, Kleinsasser A, Hoermann C, Gassner M, Keller C, Lindner K H
Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Austria.
Anesth Analg. 2000 Feb;90(2):466-71. doi: 10.1097/00000539-200002000-00042.
Laparoscopy is a surgical technique for a growing variety of abdominal operations. In patients undergoing this procedure, arterial blood oxygenation and hemodynamics are frequently depressed. This study evaluated the effect of different levels of positive end-expiratory pressure (PEEP) during intraperitoneal CO(2) insufflation on the lung's ventilation-perfusion distribution in a porcine model. We studied 13 anesthetized pigs with an intraperitoneal pressure of 15 cm H(2)O applied at either incremental values of PEEP (5-20 cm H(2)O, increments of 5 cm H(2)O) or a constant PEEP of 5 cm H(2)O. The effects of CO(2) pneumoperitoneum on inert gas exchange and hemodynamics were examined with the multiple inert gas elimination technique. During pneumoperitoneum, gas exchange was most augmented by 15 and 20 cm H(2)O of PEEP. Although the differences in hemodynamics between the individual settings were insignificant, 10 cm H(2)O of PEEP provided the smallest impairment of hemodynamics. We conclude that PEEP of 15 H(2)O during pneumoperitoneum resulted in a modest hemodynamic depression but significant gas exchange augmentation in our experiment.
Anesthetized pigs, with a pneumoperitoneum of 15 cm H(2)O, were treated either with incremental values of positive end-expiratory pressure (5-20 cm H(2)O, increments of 5 cm H(2)O) or with a constant positive end-expiratory pressure of 5 cm H(2)O. Fifteen and 20 cm H(2)O resulted in significantly improved pulmonary gas exchange compared with 5 cm H(2)O.
腹腔镜检查是一种用于越来越多腹部手术的外科技术。在接受该手术的患者中，动脉血氧合和血流动力学经常受到抑制。本研究在猪模型中评估了腹腔内二氧化碳充气期间不同水平的呼气末正压（PEEP）对肺通气-灌注分布的影响。我们研究了13只麻醉猪，腹腔内压力为15 cm H₂O，分别给予递增的PEEP值（5 - 20 cm H₂O，每次递增5 cm H₂O）或恒定的5 cm H₂O的PEEP。采用多惰性气体消除技术检查二氧化碳气腹对惰性气体交换和血流动力学的影响。在气腹期间，15和20 cm H₂O的PEEP使气体交换增加最多。尽管各设置之间血流动力学的差异不显著，但10 cm H₂O的PEEP对血流动力学的损害最小。我们得出结论，在我们的实验中，气腹期间15 cm H₂O的PEEP导致适度的血流动力学抑制，但气体交换显著增加。
对腹腔内压力为15 cm H₂O的麻醉猪，分别给予递增的呼气末正压值（5 - 20 cm H₂O，每次递增5 cm H₂O）或恒定的5 cm H₂O的呼气末正压。与5 cm H₂O相比，15和20 cm H₂O可显著改善肺气体交换。
