Greif W M, Forse R A
Harvard Center for Minimally Invasive Surgery and the Department of Surgery, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts 02215, USA.
Ann Surg. 1998 Apr;227(4):474-80. doi: 10.1097/00000658-199804000-00004.
The authors compared the hemodynamic effects of laparoscopic intervention with conventional laparotomy in an endotoxic shock model in the pig.
Laparoscopic techniques are being applied more frequently to severely ill patients to evaluate potential abdominal sources of sepsis. Although hemodynamic effects of laparoscopy are minimal in healthy patients, recent studies have shown more significant changes in patients with chronic cardiopulmonary disease. It is unclear whether these effects are applicable to acutely septic patients.
Twelve domestic pigs received intravenous lipopolysaccharide (LPS) injection and underwent surgical abdominal exploration using either laparoscopy or conventional laparotomy. For baseline comparison, four pigs underwent exploratory laparoscopy without intravenous LPS injection. Hemodynamic measurements and blood gas analyses were obtained using Swan-Ganz and arterial catheters.
After LPS exposure, animals undergoing laparoscopic evaluation were significantly more hypercarbic (p < 0.01) and acidotic (p < 0.01) than those undergoing conventional laparotomy. Their mean pulmonary arterial pressure and pulmonary vascular resistance were greater as well (not significant). The cardiac index (p < 0.05) and stroke volume (p < 0.05) were decreased in the laparoscopic group. Their oxygen delivery was decreased and oxygen consumption increased, although these were not significantly different from those of the laparotomy group. The degree of acidosis was highly correlated with the cardiac index (correlation coefficient, r = 0.82).
Animals exposed to LPS tolerate laparoscopy but with significant hemodynamic compromise. Much of this effect seems to be mediated by a cardiodepressive effect of acidosis. This study suggests that laparoscopic intervention, when used in septic patients, should be used with caution.
作者在猪的内毒素休克模型中比较了腹腔镜干预与传统开腹手术的血流动力学效应。
腹腔镜技术正越来越频繁地应用于重症患者，以评估潜在的腹部脓毒症来源。虽然腹腔镜检查对健康患者的血流动力学影响很小，但最近的研究表明，慢性心肺疾病患者会出现更显著的变化。目前尚不清楚这些影响是否适用于急性脓毒症患者。
12头家猪接受静脉注射脂多糖（LPS），然后采用腹腔镜或传统开腹手术进行腹部探查。为进行基线比较，4头猪在未静脉注射LPS的情况下接受了 exploratory laparoscopy。使用Swan-Ganz导管和动脉导管进行血流动力学测量和血气分析。
暴露于LPS后，接受腹腔镜评估的动物比接受传统开腹手术的动物出现明显更多的高碳酸血症（p < 0.01）和酸中毒（p < 0.01）。它们的平均肺动脉压和肺血管阻力也更高（不显著）。腹腔镜组的心脏指数（p < 0.05）和每搏输出量（p < 0.05）降低。它们的氧输送减少，氧消耗增加，尽管与开腹手术组相比无显著差异。酸中毒程度与心脏指数高度相关（相关系数，r = 0.82）。
暴露于LPS的动物能耐受腹腔镜检查，但会出现明显的血流动力学损害。这种影响似乎很大程度上是由酸中毒的心脏抑制作用介导的。这项研究表明，腹腔镜干预用于脓毒症患者时应谨慎使用。
