Giebler R M, Behrends M, Steffens T, Walz M K, Peitgen K, Peters J
Abteilung für Anaesthesiologie und Intensivmedizin, Universität-Gesamthochschule Essen, Essen, Federal Republic of Germany.
Anesthesiology. 2000 Jun;92(6):1568-80. doi: 10.1097/00000542-200006000-00013.
The authors hypothesized that intraperitoneal and retroperitoneal carbon dioxide insufflation during surgical procedures evoke markedly different effects on the venous low-pressure system, induce different inferior caval vein pressure gradients at similar insufflation pressures, and may provide evidence for the Starling resistor concept of abdominal venous return.
Intra- and extrathoracic caval vein pressures were measured using micromanometers during carbon dioxide insufflation at six cavity pressures (baseline and 10, 15, 20, and 24 mmHg and desufflation) in 20 anesthetized patients undergoing laparoscopic (supine, n = 8) or left (n = 6) or right (n = 6) retroperitoneoscopic (prone position) surgery. Intracavital, esophageal, and gastric pressures also were assessed. Data were analyzed for insufflation pressure-dependent and group effects by one-way and two-way analysis of variance for repeated measurements, respectively, followed by the Newman-Keuls post hoc test (P < 0.05).
Intraperitoneal, unlike retroperitoneal, insufflation markedly increased, in an insufflation pressure-dependent fashion, the inferior-to-superior caval vein pressure gradient (P < 0.00001) at the level of the diaphragm. In contrast to what was observed with retroperitoneal insufflation, transmural intrathoracic caval vein pressure increased at 10 mmHg insufflation pressure, but the increase flattened with an insufflation pressure of more than 10 mmHg, and pressure decreased with an inflation pressure of 20 mmHg (P = 0.0397). These data are consistent with a zone 2 or 3 abdominal vascular condition during intraperitoneal and a zone 3 abdominal vascular condition during retroperitoneal insufflation.
Intraperitoneal but not retroperitoneal carbon dioxide insufflation evokes a transition of the abdominal venous compartment from a zone 3 to a zone 2 condition, presumably impairing venous return, supporting the Starling resistor concept of abdominal venous return in humans.
作者推测，手术过程中腹腔内和腹膜后二氧化碳气腹对静脉低压系统产生明显不同的影响，在相似的气腹压力下诱导不同的下腔静脉压力梯度，并可能为腹部静脉回流的斯塔林电阻器概念提供证据。
在20例接受腹腔镜手术（仰卧位，n = 8）或左（n = 6）或右（n = 6）腹膜后腹腔镜手术（俯卧位）的麻醉患者中，于六个腔压力（基线、10、15、20和24 mmHg以及放气）下进行二氧化碳气腹时，使用微压计测量胸内和胸外腔静脉压力。还评估了腔内、食管和胃内压力。分别通过重复测量的单向和双向方差分析对气腹压力依赖性和组效应进行数据分析，随后进行纽曼 - 基尔斯事后检验（P < 0.05）。
与腹膜后气腹不同，腹腔内气腹以气腹压力依赖性方式显著增加了膈肌水平的下腔静脉与上腔静脉压力梯度（P < 0.00001）。与腹膜后气腹观察到的情况相反，胸内腔静脉跨壁压力在气腹压力为10 mmHg时升高，但在气腹压力超过10 mmHg时升高变平缓，且在充气压力为20 mmHg时压力降低（P = 0.0397）。这些数据与腹腔内气腹时腹部血管处于2区或3区状态以及腹膜后气腹时腹部血管处于3区状态一致。
腹腔内而非腹膜后二氧化碳气腹引起腹部静脉腔从3区状态转变为2区状态，可能损害静脉回流，支持人类腹部静脉回流的斯塔林电阻器概念。
