Davidson B S, Cromeens D M, Feig B W
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Surg Endosc. 1996 Mar;10(3):301-4. doi: 10.1007/BF00187376.
Alternative methods of exposure are needed for minimally invasive surgery to avoid hypercarbia and acidosis associated with carbon dioxide (CO2) abdominal insufflation. The goals of this study were to determine the pulmonary and hemodynamic effects of both helium (HE) abdominal insufflation and placement of a mechanical abdominal wall-lifting device (lifter) during laparoscopy.
Sixteen adult domestic pigs under general endotracheal anesthesia underwent baseline measurements of pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and arterial blood gas. Six pigs underwent standard CO2 abdominal insufflation, five pigs underwent abdominal insufflation with HE, and a lifter was used for exposure in five other animals. Sequential readings of PCWP, CO, and arterial blood gas were recorded at 20-min intervals for 60 min in all 16 animals.
No significant changes from baseline values were noted in arterial pCO2 or pH in animals who underwent placement of the lifter at any time point. After undergoing HE insufflation, animals experienced modest but significant acidosis and little change in pCO2. There was a significant rise in arterial pCO2 and decrease in pH from baseline values at all time points in animals undergoing CO2 insufflation.
This study shows that neither HE abdominal insufflation or the lifter have significant deleterious pulmonary or hemodynamic effects on experimental animals during laparoscopy. Gasless laparoscopy or HE insufflation may provide a safer alternative method of exposure for minimally invasive surgery in patients with pre-existing pulmonary or cardiac dysfunction. By minimizing risk in these patients, costly invasive monitoring may be avoided.
微创手术需要替代的暴露方法，以避免与二氧化碳（CO₂）腹腔充气相关的高碳酸血症和酸中毒。本研究的目的是确定氦气（HE）腹腔充气和腹腔镜手术期间放置机械腹壁提升装置（提升器）对肺和血流动力学的影响。
16只成年家猪在全身气管内麻醉下接受肺毛细血管楔压（PCWP）、心输出量（CO）和动脉血气的基线测量。6只猪接受标准的CO₂腹腔充气，5只猪接受HE腹腔充气，另外5只动物使用提升器进行暴露。在所有16只动物中，每隔20分钟记录一次PCWP、CO和动脉血气的连续读数，共记录60分钟。
在任何时间点接受提升器放置的动物，其动脉pCO₂或pH与基线值相比均无显著变化。接受HE充气后，动物出现轻度但显著的酸中毒，pCO₂变化不大。在接受CO₂充气的动物中，所有时间点的动脉pCO₂均显著升高，pH较基线值降低。
本研究表明，在腹腔镜手术期间，HE腹腔充气或提升器对实验动物均无显著有害的肺或血流动力学影响。无气腹腔镜或HE充气可能为患有既往肺部或心脏功能障碍的患者提供一种更安全的微创手术暴露替代方法。通过将这些患者的风险降至最低，可以避免昂贵的侵入性监测。
