Critchley L A, Critchley J A, Gin T
Department of Anaesthesia & Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
Br J Anaesth. 1993 Jun;70(6):681-3. doi: 10.1093/bja/70.6.681.
Using transthoracic electrical bioimpedance with the BoMed NCCOM3-R7, we measured cardiovascular changes in 16 ASA I and II Chinese patients undergoing laparoscopic cholecystectomy. The peritoneal cavity was insufflated with carbon dioxide to a pressure up to 15 mm Hg. Tidal volume, minute volume and end-tidal carbon dioxide partial pressure were kept constant. Insufflation resulted in a mean (SD) 13 (14)% decrease in stroke index (SI) (P < 0.01), but the effect on cardiac index (CI) was more variable (mean 7 (17)% decrease, range 36% decrease to 22% increase (P = 0.07)). Mean arterial pressure increased by 55 (29)% (P < 0.001) and systemic vascular resistance index increased by 63 (33)% (P < 0.001), with the maximum effect occurring 10-15 min after the commencement of insufflation. Multiple regression analysis showed a greater decrease in SI in patients with a small body mass index and large intraperitoneal pressure (P = 0.01), while a greater decrease in CI was found in patients with a small body mass index and younger age (P = 0.001). Three patients had a further reduction in CI during surgery, with one patient having a 48% decrease compared with pre-induction values. Deflation of the peritoneum resulted in an increase in both CI (25 (26)%) and (22 (29)%) (P < 0.01) to values which were not different from pre-induction data. Arterial blood-gas analysis showed decreases in pH and base excess after 1 h of insufflation (P < 0.01).
我们使用博迈德NCCOM3-R7经胸电阻抗技术，对16例接受腹腔镜胆囊切除术的ASA I级和II级中国患者的心血管变化进行了测量。向腹腔内注入二氧化碳，使压力达到15毫米汞柱。潮气量、分钟通气量和呼气末二氧化碳分压保持恒定。气腹导致每搏输出指数（SI）平均（标准差）下降13（14）%（P<0.01），但对心脏指数（CI）的影响变化更大（平均下降7（17）%，范围为下降36%至上升22%（P=0.07））。平均动脉压升高55（29）%（P<0.001），全身血管阻力指数升高63（33）%（P<0.001），最大效应出现在气腹开始后10 - 15分钟。多元回归分析显示，体重指数较小且腹腔内压力较大的患者SI下降幅度更大（P = 0.01），而体重指数较小且年龄较轻的患者CI下降幅度更大（P = 0.001）。3例患者在手术期间CI进一步下降，其中1例患者与诱导前值相比下降了48%。腹腔放气导致CI（25（26）%）和SI（22（29）%）均升高（P<0.01），升高后的数值与诱导前数据无差异。动脉血气分析显示，气腹1小时后pH值和碱剩余下降（P<0.01）。
