Kitajima T, Shinohara M, Ogata H
Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi, Japan.
Surg Laparosc Endosc. 1996 Jun;6(3):210-2.
To clarify the influence of carbon dioxide (CO2) on cerebral oxygen metabolism and blood volume during laparoscopy with CO2 insufflation in 12 patients who underwent laparoscopic cholecystectomy, changes in the concentrations of cerebral oxyhemoglobin (HbO2), reduced hemoglobin (HbR), total hemoglobin (total Hb), and oxidized cytochrome aa3 (Cyt aa3) were measured using near-infrared laser spectroscopy. Anesthesia was maintained with nitrous oxide (66%)-oxygen-sevoflurane. Pneumoperitoneum was maintained at an endoabdominal pressure of 10 to 12 mm Hg using CO2. Minute ventilation was constant before and after CO2 insufflation. End-tidal CO2 tension (PETCO2) increased significantly, from 33.9 +/- 1.3 to 52.8 +/- 3.3 mm Hg, after CO2 insufflation. The concentration of HbO2 increased significantly, from 0 to 7.3 +/- 2.8 mumol/L, after CO2 insufflation. The concentration of HbR increased significantly, from 0 to 2.2 +/- 1.2 mumol/L, after CO2 insufflation. Therefore, the concentration of total Hb increased significantly, from 0 to 8.8 +/- 3.3 mumol/L after CO2 insufflation. The concentration of Cyt aa3, however, did not change significantly during pneumoperitoneum. These results suggest that cellular respiration remained intact despite a concomitant increase in PETCO2 and cerebral blood volume during laparoscopy with CO2 insufflation.
为阐明二氧化碳（CO₂）对12例行腹腔镜胆囊切除术患者在二氧化碳气腹腹腔镜手术期间脑氧代谢和血容量的影响，使用近红外激光光谱法测量脑氧合血红蛋白（HbO₂）、还原血红蛋白（HbR）、总血红蛋白（总Hb）和氧化细胞色素aa₃（Cyt aa₃）浓度的变化。麻醉维持采用氧化亚氮（66%）-氧气-七氟醚。使用CO₂将气腹维持在10至12 mmHg的腹内压。CO₂气腹前后分钟通气量保持恒定。CO₂气腹后，呼气末二氧化碳分压（PETCO₂）显著升高，从33.9±1.3 mmHg升至52.8±3.3 mmHg。CO₂气腹后，HbO₂浓度显著升高，从0升至7.3±2.8 μmol/L。CO₂气腹后，HbR浓度显著升高，从0升至2.2±1.2 μmol/L。因此，CO₂气腹后总Hb浓度显著升高，从0升至8.8±3.3 μmol/L。然而，气腹期间Cyt aa₃浓度无显著变化。这些结果表明，在二氧化碳气腹腹腔镜手术期间，尽管PETCO₂和脑血容量同时增加，但细胞呼吸仍保持完整。
