Wahba R W, Béïque F, Kleiman S J
Department of Anaesthesia, McGill University, Montréal, Québec.
Can J Anaesth. 1995 Jan;42(1):51-63. doi: 10.1007/BF03010572.
This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been reported.
本综述分析了有关腹腔镜胆囊切除术期间心肺功能及术后肺功能的文献，以描述这些功能的变化模式、相关机制，并确定我们知识中值得关注的领域和空白。信息来自医学文献数据库检索以及《麻醉学》《麻醉与镇痛》《英国麻醉学杂志》和《加拿大麻醉学杂志》的年会增刊。主要发现是，气腹引起的心血管功能变化的特征是心指数立即下降、平均动脉血压和全身血管阻力增加。在接下来的几分钟内，心指数和阻力部分恢复，但血压和心率不变。这种模式是腹压升高、神经体液反应和吸收的二氧化碳之间相互作用的结果。肺功能变化的特征是顺应性降低，而动脉血氧分压（PaO2）无大幅改变，但由于氧输送减少，组织氧合可能受到不利影响。维持正常碳酸血症的一个主要困难是腹胀会降低肺顺应性以及二氧化碳吸收。呼气末二氧化碳分压不是PaCO2的可靠指标，尤其是在ASA III-IV级患者中。腹腔镜胆囊切除术后的肺功能模式的特征是肺容积和容量短暂减少，呼吸模式受限，腹部对呼吸的贡献丧失。也会发生肺不张。这些变化在性质上与“开腹”腹部手术后的变化相似，但程度较轻。结论是，腹腔镜上腹部手术期间的心肺功能变化促使我们建议对ASA III-IV级患者进行审慎的有创监测和仔细解读。尚未报道病情较重患者在广泛手术后的肺功能情况。
