在二氧化碳气腹腹腔镜胆囊切除术期间，腿部血管阻力会发生变化吗？

Are there changes in leg vascular resistance during laparoscopic cholecystectomy with CO2 pneumoperitoneum?

作者信息

Andersson L E, Jogestrand T, Thörne A, Sollevi A, Odeberg-Wernerman S

机构信息

Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, S-141 86 Huddinge, Sweden.

出版信息

Acta Anaesthesiol Scand. 2005 Mar;49(3):360-5. doi: 10.1111/j.1399-6576.2005.00623.x.

DOI:10.1111/j.1399-6576.2005.00623.x

PMID:15752402

Abstract

BACKGROUND

The prompt haemodynamic response to carbon dioxide insufflation during laparoscopic cholecystectomy suggests involvement of the sympathetic system. The aim of the present study was to examine if a change in vascular resistance in leg skeletal muscle could be an important mechanism behind the increased afterload. Furthermore, the arterio-venous differences of the catecholamines were measured in the leg before and during insufflation of carbon dioxide into the peritoneal cavity.

METHODS

Ten patients (ASA I) scheduled for laparoscopic cholecystectomy were included. After induction of anaesthesia, catheters were introduced percutaneously into the radial artery, the femoral vein and the cubital vein for pressure monitoring and blood sampling. The arterial blood flow in the legs was measured by mercury-in-Silastic strain gauge venous occlusion plethysmography. Vascular resistance in the right leg (LVR) was calculated from the formula: (MAP-FVP)/calf blood flow. Measurements were made before and 5 min after insufflation of pneumoperitoneum.

RESULTS

Induction of pneumoperitoneum increased the heart rate (P < 0.05) and also increased mean arterial pressure and femoral vein pressure as well as the calculated leg vascular resistance (P < 0.01). Calf blood flow did not change significantly in either leg. Both arterial and venous noradrenaline concentrations were higher after insufflation (P < 0.01).

CONCLUSION

In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg increased the peripheral vascular resistance in the leg while the arterial blood flow in the leg was unaffected. Catecholamine levels increased, but were still low. Therefore, we suggest that the increase in peripheral vascular resistance is caused by increased myogenic activity in the resistance vessels secondary to increased arterial and transmural pressure rather than by increased neurogenic sympathetic activity.

摘要

背景

腹腔镜胆囊切除术期间对二氧化碳气腹的快速血流动力学反应提示交感神经系统参与其中。本研究的目的是检验腿部骨骼肌血管阻力的变化是否可能是后负荷增加背后的一个重要机制。此外，在向腹腔内注入二氧化碳之前和期间，测量腿部儿茶酚胺的动静脉差异。

方法

纳入10例计划行腹腔镜胆囊切除术的患者（美国麻醉医师协会身体状况分级I级）。麻醉诱导后，经皮将导管插入桡动脉、股静脉和肘静脉，用于压力监测和采血。通过汞填充硅橡胶应变片静脉阻塞体积描记法测量腿部的动脉血流。根据公式：（平均动脉压-股静脉压）/小腿血流量，计算右腿的血管阻力（LVR）。在气腹注入前和注入后5分钟进行测量。