Martín-Cancho María F, Crisóstomo Verónica, Soria Federico, Calles Carmen, Sánchez-Margallo Francisco M, Díaz-Güemes Idoia, Usón-Gargallo Jesús
Minimally Invasive Surgery Centre Jesús Usón, Carretera Nac. 521, Km 41.8, 10071 Cáceres, Spain.
Anesthesiol Res Pract. 2008;2008:581948. doi: 10.1155/2008/581948. Epub 2008 Mar 27.
The aim of this study was to compare the hemodynamic and ventilatory effects of prolonged infrarenal aortic cross-clamping in pigs undergoing either laparotomy or laparoscopy. 18 pigs were used for this study. Infrarenal aortic crossclamping was performed for 60 minutes in groups I (laparotomy, n = 6) and II (laparoscopy, n = 6). Group III (laparoscopy, n = 6) underwent a 120-minute long pneumoperitoneum in absence of aortic clamping (sham group). Ventilatory and hemodynamic parameters and renal function were serially determined in all groups. A significant decrease in pH and significant increase in PaCO(2) were observed in group II, whereas no changes in these parameters were seen in group I and III. All variables returned to values similar to baseline in groups I and II 60 minutes after declamping. A significant increase in renal resistive index was evidenced during laparoscopy, with significantly higher values seen in Group II. Thus a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause decreased renal perfusion and acidosis, thus negatively affecting the patient's general state during this type of surgery.
本研究的目的是比较在接受剖腹手术或腹腔镜手术的猪中，长时间肾下主动脉交叉钳夹对血流动力学和通气的影响。本研究使用了18头猪。在第一组（剖腹手术，n = 6）和第二组（腹腔镜手术，n = 6）中进行肾下主动脉交叉钳夹60分钟。第三组（腹腔镜手术，n = 6）在无主动脉钳夹的情况下进行120分钟的气腹（假手术组）。在所有组中连续测定通气和血流动力学参数以及肾功能。在第二组中观察到pH值显著降低和PaCO₂显著升高，而在第一组和第三组中这些参数没有变化。在松开钳夹60分钟后，第一组和第二组中的所有变量均恢复到与基线相似的值。在腹腔镜手术期间，肾阻力指数显著增加，在第二组中观察到的值显著更高。因此，在本研究中观察到气腹和主动脉交叉钳夹的协同作用。这两个因素共同导致肾灌注减少和酸中毒，从而在这类手术期间对患者的一般状态产生负面影响。
