人体二氧化碳气腹期间的胸腔和肺血容量

Intrathoracic and pulmonary blood volume during CO2-pneumoperitoneum in humans.

作者信息

Hachenberg T, Ebel C, Czorny M, Thomas H, Wendt M

机构信息

Department of Anaesthesiology, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.

出版信息

Acta Anaesthesiol Scand. 1998 Aug;42(7):794-8. doi: 10.1111/j.1399-6576.1998.tb05324.x.

DOI:10.1111/j.1399-6576.1998.tb05324.x

PMID:9698955

Abstract

BACKGROUND

Induction of CO2-pneumoperitoneum may have significant effects on systemic and pulmonary haemodynamics. We hypothesized that intrathoracic (ITBV) and pulmonary blood volume (PBV) are affected during intra-abdominal CO2-insufflation, which may be pronounced by positional changes of the patient.

METHODS

Sixteen anaesthetized patients were studied before, during and after CO2-pneumoperitoneum for laparoscopic cholecystectomy. A dye indicator technique was used to assess ITBV and PBV. In addition, gas exchange and haemodynamics were recorded.

RESULTS

In the supine position, induction of CO2-pneumoperitoneum had no effects on ITBV, PBV and cardiac output. Mean systemic arterial pressure increased from 10.9 +/- 1.5 kPa (82 +/- 11 mmHg) to 12.7 +/- 1.5 kPa (95 +/- 11 mmHg, P < 0.01). In the reverse Trendelenburg position ITBV decreased from 19.8 +/- 5.1 ml.kg-1 to 16.7 +/- 3.7 ml.kg-1 (P < 0.05) during CO2-insufflation, but increased to control values after 20 min. PBV decreased from 4.2 +/- 1.2 ml.kg-1 to 3.4 +/- 1.1 ml.kg (P < 0.05) and remained decreased during CO2-pneumoperitoneum. Calculated venous admixture was unchanged throughout the study. Deflation of CO2-pneumoperitoneum increased ITBV (22.4 +/- 5.2 ml.kg-1, P < 0.05) and cardiac output above control values.

CONCLUSIONS

In anaesthetized-paralyzed patients in the reverse Trendelenburg position intra-abdominal CO2-insufflation is associated with significant alterations of ITBV and PBV. The release of CO2-pneumoperitoneum is associated with a re-distribution of blood into the thorax.

摘要

背景

二氧化碳气腹的诱导可能对全身和肺部血流动力学产生显著影响。我们假设在腹腔内注入二氧化碳期间，胸腔内血容量（ITBV）和肺血容量（PBV）会受到影响，而患者体位的改变可能会使这种影响更加明显。

方法

对16例接受腹腔镜胆囊切除术的麻醉患者在二氧化碳气腹前、气腹期间和气腹后进行了研究。采用染料指示剂技术评估ITBV和PBV。此外，还记录了气体交换和血流动力学情况。

结果

在仰卧位时，二氧化碳气腹的诱导对ITBV、PBV和心输出量没有影响。平均体动脉压从10.9±1.5千帕（82±11毫米汞柱）升至12.7±1.5千帕（95±11毫米汞柱，P<0.01）。在头高脚低位时，二氧化碳注入期间ITBV从19.8±5.1毫升·千克⁻¹降至16.7±3.7毫升·千克⁻¹（P<0.05），但20分钟后升至对照值。PBV从4.2±1.2毫升·千克⁻¹降至3.4±1.1毫升·千克（P<0.05），并在二氧化碳气腹期间持续降低。整个研究过程中计算出的静脉混合血未发生变化。二氧化碳气腹放气后ITBV增加（22.4±5.2毫升·千克⁻¹，P<0.05），心输出量高于对照值。