Marathe U S, Lilly R E, Silvestry S C, Schauer P R, Davis J W, Pappas T N, Glower D D
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Surg Endosc. 1996 Oct;10(10):974-8. doi: 10.1007/s004649900217.
Carbon dioxide (CO2) pneumoperitoneum has been shown to adversely affect hemodynamics in patients. This study specifically examines the potential contribution of altered left ventricular contractility (LVC) to hemodynamic changes observed during CO2 pneumoperitoneum.
In a canine model, LV volumes, LV pressure, and intrathoracic and central venous pressures were recorded both at basal intra-abdominal pressure (IAP) and after CO2 insufflation to produce IAPs of 5-25 mmHg.
At IAPs greater than 15 mmHg, cardiac output and LV end-diastolic volume decreased. Mean arterial pressure and heart rate were unchanged. LVC, quantified using the linear Frank-Starling relationship, was not affected by increases in IAP.
This study is the first to quantify LVC during CO2 pneumoperitoneum and demonstrates no changes in contractility over IAPs from 5 to 25 mmHg. In the dog model, any hemodynamic alterations induced by CO2 pneumoperitoneum are secondary to altered LV preload and not alterations in contractility or LV afterload.
二氧化碳气腹已被证明会对患者的血流动力学产生不利影响。本研究专门探讨左心室收缩力（LVC）改变对二氧化碳气腹期间观察到的血流动力学变化的潜在影响。
在犬模型中，在基础腹腔内压（IAP）以及二氧化碳注入后使IAP达到5 - 25 mmHg时，记录左心室容积、左心室压力以及胸内和中心静脉压力。
当IAP大于15 mmHg时，心输出量和左心室舒张末期容积降低。平均动脉压和心率未改变。使用线性Frank - Starling关系量化的LVC不受IAP升高的影响。
本研究首次在二氧化碳气腹期间量化了LVC，并表明在5至25 mmHg的IAP范围内收缩力无变化。在犬模型中，二氧化碳气腹引起的任何血流动力学改变均继发于左心室前负荷的改变，而非收缩力或左心室后负荷的改变。
