Rademaker B M, Bannenberg J J, Kalkman C J, Meyer D W
Department of Anesthesiology, University of Amsterdam, The Netherlands.
J Laparoendosc Surg. 1995 Feb;5(1):15-20. doi: 10.1089/lps.1995.5.15.
Pneumoperitoneum with CO2 is associated with adverse effects, such as hypercarbia, arrhythmias, and circulatory depression, which may limit its use in patients with underlying disease. Some of these effects may be caused by CO2 absorption resulting in acid-base disturbances. Laparoscopic insufflation with helium may be a good alternative for CO2, since it is chemically inert. Because there are few data on the use of helium for laparoscopy, we studied hemodynamics and gas exchange during insufflation with CO2 or helium in 8 pigs at 10, 15, and 20 mm Hg intraabdominal pressure. Heart rate did not change significantly with both gases. Arterial blood pressure increased with CO2 (p < 0.05) but not with helium. Cardiac output, mixed venous oxygen saturation, and oxygen consumption did not decrease, whereas central venous filling pressures increased during insufflation with either gas. Insufflation with CO2 resulted in mild increases in arterial, central venous, and end-expiratory CO2. The results suggest that pneumoperitoneum with helium will not be associated with profound circulatory depression or oxygen transport abnormalities. In addition, the use of helium is not associated with acid-base disturbances, although central venous filling pressures are similarly increased as with the use of CO2 pneumoperitoneum.
二氧化碳气腹会带来一些不良影响，如高碳酸血症、心律失常和循环抑制，这可能会限制其在患有基础疾病患者中的应用。其中一些影响可能是由二氧化碳吸收导致酸碱平衡紊乱引起的。氦气腹腔镜充气可能是二氧化碳的一个良好替代方案，因为它具有化学惰性。由于关于氦气用于腹腔镜手术的数据较少，我们研究了8头猪在腹腔内压力为10、15和20毫米汞柱时，使用二氧化碳或氦气充气期间的血流动力学和气体交换情况。两种气体充气时心率均无显著变化。二氧化碳充气时动脉血压升高（p < 0.05），而氦气充气时动脉血压未升高。心输出量、混合静脉血氧饱和度和氧耗量均未降低，而两种气体充气期间中心静脉充盈压均升高。二氧化碳充气导致动脉血、中心静脉血和呼气末二氧化碳轻度升高。结果表明，氦气气腹不会导致严重的循环抑制或氧运输异常。此外，使用氦气与酸碱平衡紊乱无关，尽管中心静脉充盈压与使用二氧化碳气腹时同样升高。
