Fahy B G, Barnas G M, Nagle S E, Flowers J L, Njoku M J, Agarwal M
Department of Anesthesiology, University of Maryland, Baltimore, USA.
Anesth Analg. 1996 Mar;82(3):501-5. doi: 10.1097/00000539-199603000-00013.
Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.
此前我们曾报道，在腹腔镜手术期间，向腹腔内注入二氧化碳会导致肺和胸壁弹性以及肺阻力大幅增加。为了研究这些影响在腹腔放气后是否可逆，我们通过测量17例接受腹腔镜手术的麻醉/麻痹患者的气道流量、压力和食管压力，计算了肺和胸壁的弹性及阻力。在腹腔充气前和放气后进行测量。肺和胸壁的弹性及阻力与基线相比无变化（P>0.05），尽管总呼吸弹性与基线相比仍略有增加（P<0.05）。总呼吸弹性的变化与腹腔充气时间、手术部位、吸烟史或患者的身体特征无关。腹腔充气前后弹性及阻力的频率和潮气量依赖性无差异（P>0.5）。我们得出结论，腹腔镜手术期间二氧化碳充气引起的呼吸力学残余变化较小，并且腹腔镜检查后肺功能测试所报告的呼吸功能损害似乎并非由于肺或胸壁的被动力学特性改变所致。
