Catani Marco, Guerricchio Renato, De Milito Ritanna, Capitano Sante, Chiaretti Massimo, Guerricchio Andrea, Manili Gianluca, Simi Mario
Dipartimento di Chirurgia Paride Stefanini, Università La Sapienza di Roma.
Chir Ital. 2004 Jan-Feb;56(1):71-80.
The insufflation pressure used for laparoscopic cholecystectomy is usually 12-15 mm Hg, and a pneumoperitoneum with carbon dioxide has a significant effect on both cardiovascular and respiratory function. These effects are transient in young, healthy patients, but may be dangerous in ASA III and IV patients with a poor cardiac reserve. This study was designed to assess the feasibility of performing laparoscopic cholecystectomy at 6.5-8 mm Hg insufflation pressure in "high-risk" patients. Thirteen patients, 10 ASA III and 3 ASA IV, with cholelithiasis, were included in this study The insufflation pressure was 6.5-8 mm Hg, with a 10 degrees anti-Trendelenburg position. The cardiovascular and blood gas variables studied were: mean arterial blood pressure, heart rate, respiratory rate, and end-tidal CO2 pressure. The authors reported no conversions and no intra- or postoperative complications. During insufflation heart rate and mean arterial blood pressure increased minimally if compared with laparoscopic cholecystectomy at 12-15 mm Hg. Pa CO2 increased after insufflation (+5 mm Hg), and the end-tidal CO2 pressure gradient was moderate (3.5 mm Hg) and unchanged during surgery. A low-pressure pneumoperitoneum is feasible for laparoscopic cholecystectomy and minimizes the adverse haemodynamic effects of peritoneal insufflation.
腹腔镜胆囊切除术所使用的气腹压力通常为12 - 15毫米汞柱，二氧化碳气腹对心血管和呼吸功能均有显著影响。在年轻健康的患者中，这些影响是短暂的，但对于心脏储备功能差的美国麻醉医师协会（ASA）III级和IV级患者可能是危险的。本研究旨在评估在“高危”患者中以6.5 - 8毫米汞柱的气腹压力进行腹腔镜胆囊切除术的可行性。本研究纳入了13例患有胆结石的患者，其中10例为ASA III级，3例为ASA IV级。气腹压力为6.5 - 8毫米汞柱，采取头高脚低10度体位。所研究的心血管和血气变量包括：平均动脉血压、心率、呼吸频率和呼气末二氧化碳分压。作者报告无一例中转开腹，且无术中及术后并发症。与12 - 15毫米汞柱气腹压力的腹腔镜胆囊切除术相比，在气腹过程中，心率和平均动脉血压仅有轻微升高。气腹后动脉血二氧化碳分压升高（+5毫米汞柱），呼气末二氧化碳分压梯度适中（3.5毫米汞柱）且在手术过程中无变化。低压力气腹用于腹腔镜胆囊切除术是可行的，并且可将气腹对血流动力学的不良影响降至最低。
