腹腔镜腹壁结构分离治疗腹腔内高压的动物实验

Laparoscopic abdominal wall components separation in a porcine model of intra-abdominal hypertension

目的通过动物实验，研究腹腔镜腹壁结构分离技术治疗腹腔内高压的效果。方法8头巴马香猪于全麻下手术，通过腹腔灌注CO2建立腹腔高压（IAH）模型。于腹肌平面上方建立皮下隧道，在腹腔镜的监测下以超声刀切开腹外斜肌腱膜的止点，记录术前、单侧减压和双侧减压后的腹腔内压（IAP）、腰围（WL）、中心静脉压（CVP）、平均动脉压（MAP）和心率（HR）的变化。结果建立IAH（25mm Hg）后，WL为（65．3±2．5）cm，MAP为（88±14）mmHg，HR为（115±9）次／min，CVP为（10．8±2．2）cmH2O。实施腹腔镜腹壁结构分离后，IAP降至（16．0±1．5）mmHg（P〈0．01），WL升至（83．1±1．9）cm（P〈0．01），MAP升至（100±12）mmHg（P〈0．01），HR降至（97±7）次／min（P〈0．01），CVP降至（7．3±1．8）cmH2O（P〈0．01）。结论IAP的变化可引起巴马香猪的血液动力学改变，腹腔镜腹壁结构分离技术可显著降低其IAH，从而改善血液动力学。

Objective To determine the effect of laparoscopic abdominal wall components separation procedure on a porcine model of intra-abdominal hypertension （IAH）. Methods IAH to 25 mm Hg was created by insufflating carbon dioxide into abdominal cavity of eight anesthetized pigs. Bilateral subcutaneous tunnels above the plane of the abdominal musculature were developed. Dissection of the external oblique insertion and development of the plane between external and internal oblique muscles was performed using ultrasonic scalpel monitored by laparoscopy. Changes in intra-abdominal pressure （IAP）, waistline （WL）, mean arterial pressure （MAP）, heart rate （HR）, central venous pressure （CVP） were recorded. Results Following intra-abdominal hypertension, WL, MAP, HR and CVP changed significantly. After laparoscopic abdominal wall components separation, there was a significant decrease in IAP from 25 mm Hg to （ 16.0 ± 1.5） mm Hg （ P 〈 0. 01 ）. Also, this procedure increased WL by （5.6 ± 2. 0） cm [from （65. 3 ±2. 5） cm to （88 ± 14） cm; P 〈0. 01 ]. Due to abdominal depression, the MAP was significantly increased from to （88 ± 14） mm Hg to （ 100 ± 12） mm Hg （P 〈0. 01 ）. Moreover, there were significant improvements in circulation status including HR from （115 ± 9） beat per minute （bpm） to （97 ± 7） bpm （P 〈0.01）, CVP from （10.8 ±2.2） cm H2O to （7.3 ±1.8） cm H2O （P 〈0.01）, etc. Conclusions IAH results in changes of hemodynamics. Laparoscopic abdominal wall components separation significantly decreases IAH improving porcine hemodynamics.