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全内镜冠状动脉搭桥术中二氧化碳气腹时的血流动力学和气体交换

Hemodynamics and gas exchange during carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting.

作者信息

Byhahn C, Mierdl S, Meininger D, Wimmer-Greinecker G, Matheis G, Westphal K

机构信息

Department of Anesthesiology, JW Goethe-University Hospital, Frankfurt, Germany.

出版信息

Ann Thorac Surg. 2001 May;71(5):1496-501; discussion 1501-2. doi: 10.1016/s0003-4975(01)02428-6.

Abstract

BACKGROUND

In addition to single-lung ventilation (SLV), positive-pressure CO2 insufflation is mandatory for totally endoscopic coronary artery bypass grafting. Studies on the effects of unilateral CO2 insufflation on hemodynamics produced controversial results, and bilateral insufflation has not been studied to our knowledge. The present study sought to investigate hemodynamics and gas exchange during unilateral and bilateral CO2 insufflation in patients who underwent totally endoscopic coronary artery bypass grafting.

METHODS

Eleven hemodynamic and gas exchange variables were monitored during 22 totally endoscopic coronary artery bypass grafting procedures with unilateral (n = 17) or bilateral (n = 5) CO2 insufflation at a pressure of 10 to 12 mm Hg. Data were obtained at baseline with double-lung ventilation, after institution of SLV, during insufflation, after cardiopulmonary bypass during SLV, and after return to double-lung ventilation.

RESULTS

Arterial oxygen tension decreased significantly during SLV, whereas the peak inspiratory pressure increased. In addition, central venous pressure and heart rate increased significantly during insufflation, but mean arterial pressure remained unchanged. Although the end-tidal CO2 pressure did not change, arterial carbon dioxide tension increased progressively to a maximum of 44.6 +/- 5.9 mm Hg during unilateral insufflation, and 55.7 +/- 14.6 mm Hg during bilateral insufflation (p < 0.05 versus baseline and between groups). Mixed venous oxygen saturation declined during SLV regardless of CO2 insufflation and recovered to baseline once double-lung ventilation was restarted. Left and right ventricular ejection fractions remained unaltered. No patient required inotropic or vasopressor support.

CONCLUSIONS

Carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting with SLV had no adverse effects on hemodynamics. In contrast to a moderate increase of arterial carbon dioxide tension during unilateral insufflation, markedly elevated arterial carbon dioxide tension levels remain a cause of concern during bilateral insufflation.

摘要

背景

除单肺通气(SLV)外,全胸腔镜冠状动脉旁路移植术必须进行正压二氧化碳吹入。关于单侧二氧化碳吹入对血流动力学影响的研究结果存在争议,据我们所知,尚未对双侧吹入进行研究。本研究旨在调查接受全胸腔镜冠状动脉旁路移植术患者在单侧和双侧二氧化碳吹入期间的血流动力学和气体交换情况。

方法

在22例全胸腔镜冠状动脉旁路移植手术中,以10至12 mmHg的压力进行单侧(n = 17)或双侧(n = 5)二氧化碳吹入,监测11项血流动力学和气体交换变量。在双肺通气基线时、开始SLV后、吹入期间、体外循环后SLV期间以及恢复双肺通气后获取数据。

结果

SLV期间动脉血氧分压显著下降,而吸气峰压升高。此外,吹入期间中心静脉压和心率显著增加,但平均动脉压保持不变。虽然呼气末二氧化碳压力未改变,但动脉二氧化碳分压在单侧吹入期间逐渐升高至最高44.6±5.9 mmHg,双侧吹入期间为55.7±14.6 mmHg(与基线相比及组间比较,p < 0.05)。无论是否进行二氧化碳吹入,SLV期间混合静脉血氧饱和度均下降,恢复双肺通气后恢复至基线水平。左、右心室射血分数保持不变。无患者需要使用正性肌力药物或血管升压药支持。

结论

全胸腔镜冠状动脉旁路移植术联合SLV进行二氧化碳吹入对血流动力学无不良影响。与单侧吹入期间动脉二氧化碳分压适度升高相比,双侧吹入期间动脉二氧化碳分压显著升高仍是一个值得关注的问题。

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