Jones D R, Graeber G M, Tanguilig G G, Hobbs G, Murray G F
Department of Surgery, West Virginia University School of Medicine, Morgantown 26506-9238.
Ann Thorac Surg. 1993 Jun;55(6):1379-82. doi: 10.1016/0003-4975(93)91074-w.
Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.
曾经需要开胸手术的胸部手术现在可通过电视辅助胸腔镜进行。为了充分观察胸内结构，有人主张在正压下通过二氧化碳充气制造人工气胸。我们推测胸腔镜检查期间的正压充气会导致明显的血流动力学损害。八只健康的雌性猪接受了全身气管内麻醉并放置了监测线。放置胸腔镜后，在0毫米汞柱（大气压）下获得基线血流动力学测量值。在每个压力稳定后，使用二氧化碳充气在5、10和15毫米汞柱下随机进行测量。使用Page检验对非参数变量进行数据分析。5毫米汞柱或更高的充气压力导致心脏指数、平均动脉压、每搏量和左心室每搏功指数显著降低，而中心静脉压升高（p<0.001）。心率变化不显著。由于我们实验模型中存在明显的血流动力学损害，我们不建议在胸腔镜检查期间常规进行正压充气。
