Fernández-Cruz L, Sáenz A, Taurá P, Sabater L, Astudillo E, Fontanals J
Department of Surgery, Hospital Clinic, University of Barcelona, Spain.
World J Surg. 1998 Dec;22(12):1250-5. doi: 10.1007/s002689900554.
Insufflation with helium is used to prevent respiratory acidosis, hypercapnia, and cardiovascular instability associated with carbon dioxide (CO2) pneumoperitoneum. The aim of this prospective study was to compare CO2 with helium pneumoperitoneum with special reference to respiratory and hemodynamic changes at different times during the operation. Altogether 22 pheochromocytoma patients undergoing laparoscopic adrenalectomy (LpA) were included using CO2 in 11 patients (CO2LpA) and helium in 11 patients (HeLpA). The insufflation pressure was 12 mmHg. The two groups were comparable with regard to demographic data and preoperative management. CO2 and helium insufflation were associated with similar catecholamine increase. The most striking significant increase compared with the baseline was observed during tumor isolation: The mean plasma epinephrine (EPI) and norepinephrine (NE) levels increased 32.86-fold and 25.92-fold, respectively, in the CO2LpA patients and 27.43-fold and 18.46-fold, respectively, in the HeLpA patients. HeLpA did not result in significant hypercarbia or acidosis at any measured intraoperative point; this was without any alteration in minute ventilation to maintain these normal PaCO2, excess base (EB), and pH values. Significant increases of mean arterial pressure, pulmonary arterial pressure, pulmonary vascular resistance index, PaCO2, EB, and acidosis were seen in the CO2LpA patients at the time of tumor isolation and tumor removal compared with those in HeLpA patients. No patient required conversion to open surgery. There were no significant differences between CO2LpA and HeLpA regarding mean operative time (117.50 +/- 93.68 vs. 106.87 +/- 16.60 minutes), mean blood loss (168.54 +/- 78.63 vs. 142.02 +/- 109.26 ml), hospital stay (4 days), the need for analgesics, or mean time required to return to normal activity (12 days). There was one wound infection in the HeLpA group and one wound hematoma and one case of atelectasis in the CO2LpA group. Helium may be the agent of choice for abdominal insufflation in patients undergoing LpA for pheochromocytoma, eliminating the adverse hemodynamic and respiratory changes associated with CO2 insufflation.
使用氦气吹入法来预防与二氧化碳（CO₂）气腹相关的呼吸性酸中毒、高碳酸血症和心血管不稳定。这项前瞻性研究的目的是比较CO₂气腹和氦气气腹，特别关注手术过程中不同时间点的呼吸和血流动力学变化。共有22例接受腹腔镜肾上腺切除术（LpA）的嗜铬细胞瘤患者被纳入研究，其中11例患者使用CO₂（CO₂LpA组），11例患者使用氦气（HeLpA组）。吹入压力为12 mmHg。两组在人口统计学数据和术前管理方面具有可比性。CO₂和氦气吹入均导致类似的儿茶酚胺升高。与基线相比，在肿瘤分离期间观察到最显著的升高：CO₂LpA组患者血浆肾上腺素（EPI）和去甲肾上腺素（NE）的平均水平分别升高32.86倍和25.92倍，HeLpA组患者分别升高27.43倍和18.46倍。在任何测量的术中时间点，HeLpA组均未导致显著的高碳酸血症或酸中毒；维持这些正常的动脉血二氧化碳分压（PaCO₂）、碱过剩（EB）和pH值时，分钟通气量没有任何改变。与HeLpA组患者相比，CO₂LpA组患者在肿瘤分离和肿瘤切除时平均动脉压、肺动脉压、肺血管阻力指数、PaCO₂、EB和酸中毒均显著升高。没有患者需要转为开放手术。CO₂LpA组和HeLpA组在平均手术时间（分别为117.50±93.68分钟和106.87±16.60分钟）、平均失血量（分别为168.54±78.63 ml和142.02±109.26 ml）、住院时间（4天）、镇痛需求或恢复正常活动所需的平均时间（12天）方面没有显著差异。HeLpA组有1例伤口感染，CO₂LpA组有1例伤口血肿和1例肺不张。对于接受嗜铬细胞瘤LpA手术患者，氦气可能是腹部吹入的首选气体，可消除与CO₂吹入相关的不良血流动力学和呼吸变化。
