Feig B W, Berger D H, Dougherty T B, Dupuis J F, Hsi B, Hickey R C, Ota D M
Department of Surgical Oncology, UTM.D. Anderson Cancer Center, Houston 77030.
Surgery. 1994 Oct;116(4):733-9; discussion 739-41.
Several studies in both animal models and human beings have shown that CO2 abdominal insufflation for laparoscopy can cause a variety of alterations in hemodynamic and pulmonary physiology. These physiologic changes could potentially have deleterious effects in patients with underlying cardiopulmonary disease.
We prospectively evaluated 15 patients with preexisting heart and/or lung disease to determine whether the use of invasive monitoring would allow early identification and treatment of these physiologic alterations and thus enable laparoscopy to be performed safely in this group of patients.
CO2 abdominal insufflation caused statistically significant increases in systemic vascular resistance, mean arterial pressure, left ventricular stroke work index, and pulmonary capillary wedge pressure along with a concomitant decrease in cardiac index and oxygen delivery in these patients. The use of intravenous nitroglycerin resulted in a rapid return of the systemic vascular resistance, mean arterial pressure, pulmonary capillary wedge pressure, and cardiac index to baseline levels. No significant intraoperative or postoperative cardiac or pulmonary complications were noted.
These results suggest that laparoscopy with CO2 pneumoperitoneum can be safely performed in high-risk patients if appropriate monitoring and pharmacologic interventions are used.
在动物模型和人类中进行的多项研究表明，腹腔镜检查时的二氧化碳气腹可导致血流动力学和肺生理学的多种改变。这些生理变化可能会对患有潜在心肺疾病的患者产生有害影响。
我们前瞻性地评估了15例患有心脏病和/或肺病的患者，以确定使用有创监测是否能早期识别和治疗这些生理改变，从而使腹腔镜检查能够在这组患者中安全进行。
在这些患者中，二氧化碳气腹导致全身血管阻力、平均动脉压、左心室每搏功指数和肺毛细血管楔压在统计学上显著升高，同时心脏指数和氧输送量下降。静脉注射硝酸甘油使全身血管阻力、平均动脉压、肺毛细血管楔压和心脏指数迅速恢复到基线水平。术中或术后未发现明显的心脏或肺部并发症。
这些结果表明，如果采用适当的监测和药物干预措施，在高危患者中进行二氧化碳气腹腹腔镜检查是安全可行的。
