Rishimani A S, Gautam S C
Fujairah Hospital, United Arab Emirates.
Surg Laparosc Endosc. 1996 Jun;6(3):201-4.
Laparoscopic cholecystectomy (lapchole) is a safe procedure. Most of the complications are operation related. The complications related to increased intraabdominal pressure (IAP) are well recognized, but not emphasized enough. The changes in physiological parameters at different IAPs were studied to evaluate the usefulness of reduced IAP in minimizing these changes. Thirty consecutive patients consisting of 16 ASA III, 2 ASA IV, and the rest ASA I and II, underwent lapchole under high and reduced IAP. The mean arterial pressure (MAP), heart rate (HR), arterial oxygen saturation (SaO2), airway pressure (AWP), and end-tidal carbon dioxide (ETCO2) were recorded before insufflating carbon dioxide (T1), with IAP of 14 mm Hg (T2) and IAP of 6 mm Hg or less (T3). At T2, MAP increased by 41.15%, AWP by 44.3%, and ETCO2 by 20.5% as compared to T1 (p < 0.001). HR and SaO2 showed no significant changes. At T3 there was an increase in MAP by 24.94%, in AWP by 10%, and ETCO2 by 10.6% with no significant changes in HR and SaO2. Thus, operating under reduced IAP may be beneficial to the patients with decreased cardiopulmonary reserve, especially while undergoing long surgical procedures.
腹腔镜胆囊切除术是一种安全的手术。大多数并发症与手术相关。与腹内压（IAP）升高相关的并发症已得到充分认识，但未得到足够重视。研究了不同IAP下生理参数的变化，以评估降低IAP在最小化这些变化方面的作用。连续30例患者，其中16例ASA III级，2例ASA IV级，其余为ASA I级和II级，在高IAP和降低IAP下接受腹腔镜胆囊切除术。在注入二氧化碳前（T1）、IAP为14 mmHg时（T2）和IAP为6 mmHg或更低时（T3）记录平均动脉压（MAP）、心率（HR）、动脉血氧饱和度（SaO2）、气道压力（AWP）和呼气末二氧化碳（ETCO2）。与T1相比，T2时MAP升高41.15%，AWP升高44.3%，ETCO2升高20.5%（p<0.001）。HR和SaO2无显著变化。T3时MAP升高24.94%，AWP升高10%，ETCO2升高10.6%，HR和SaO2无显著变化。因此，在降低IAP下进行手术可能对心肺储备功能下降的患者有益，尤其是在进行长时间手术时。
