Polis I, Gasthuys F, Gielen I, Van Ryssen B, Van Bree H, Laevens H, De Rijcke L
Department of Small Animal Medicine and Clinical Biology, Ghent University, Belgium.
J Vet Med A Physiol Pathol Clin Med. 2002 Apr;49(3):113-20. doi: 10.1046/j.1439-0442.2002.00404.x.
The cardiopulmonary effects of different levels of carbon dioxide insufflation (3, 5 and 2 mm Hg) under two-lung ventilation were studied in six sevoflurane (1.5 minimum alveolar concentration; MAC) anaesthetized dogs during left-sided thoracoscopy. An arterial catheter, Swan-Ganz catheter and multianaesthetic gas analyser were used to monitor the cardiopulmonary parameters during the experiment. Baseline data were obtained before intrathoracic pressure elevation and the measurements were repeated at intervals after left lung collapse induced by insufflation with carbon dioxide gas. The intrapleural pressure levels used were 3, 5 and 2 mm Hg. Arterial blood pressures, cardiac index, stroke index, left and right ventricular stroke work index, arterial haemoglobin saturation, arterial oxygen tension and systemic vascular resistance decreased significantly during hemithorax insufflation, whereas heart rate, right atrial pressure, mean, systolic and diastolic pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance and arterial carbon dioxide tension significantly increased during intrapleural pressure elevation. Although carbon dioxide insufflation into the left hemithorax with an intrapleural pressure of 2-5 mm Hg compromises cardiac functioning in 1.5 MAC sevoflurane anaesthetized dogs, it can be an efficacious adjunct for thoracoscopic procedures. Intrathoracic view was satisfactory with an intrapleural pressure of 2 mm Hg. Therefore, the intrathoracic pressure rise during thoracoscopy with two-lung ventilation should be kept as low as possible. Additional insufflation periods should be avoided, since a more rapid and more severe cardiopulmonary depression can occur.
在六只接受七氟醚（1.5最低肺泡浓度；MAC）麻醉的犬进行左侧胸腔镜检查期间，研究了双肺通气下不同水平二氧化碳气腹（3、5和2毫米汞柱）的心肺效应。实验期间使用动脉导管、Swan-Ganz导管和多麻醉气体分析仪监测心肺参数。在胸腔内压力升高前获取基线数据，并在通过注入二氧化碳气体导致左肺萎陷后的不同时间间隔重复测量。所使用的胸膜腔内压力水平为3、5和2毫米汞柱。在半胸气腹期间，动脉血压、心脏指数、每搏指数、左右心室每搏功指数、动脉血红蛋白饱和度、动脉血氧张力和全身血管阻力显著下降，而在胸膜腔内压力升高期间，心率、右心房压力、平均、收缩和舒张肺动脉压、肺毛细血管楔压、肺血管阻力和动脉二氧化碳张力显著增加。尽管在1.5MAC七氟醚麻醉的犬中，向左半胸注入胸膜腔内压力为2至5毫米汞柱的二氧化碳会损害心脏功能，但它可以作为胸腔镜手术的有效辅助手段。胸膜腔内压力为2毫米汞柱时胸腔内视野良好。因此，双肺通气胸腔镜检查期间胸腔内压力升高应尽可能保持在低水平。应避免额外的气腹期，因为可能会发生更快速、更严重的心肺抑制。
