兔颈部CO_2和生理盐水灌注内镜甲状腺手术

Endoscopic thyroidectomy with filling the neck of rabbits with carbon dioxide and saline

目的:在兔颈部皮下灌注CO2和生理盐水以营造手术空间完成甲状腺切除术。检测不同压力和持续灌注时间对代谢、血流动力学参数、Na+以及红细胞压积(HCT)的影响。方法:将21只新西兰兔随机分成7组,分别为颈部不充递质对照组、0.67kPaCO2组、1.33kPaCO2组、2.00kPaCO2组、0.67kPa生理盐水组、1.33kPa生理盐水组和2.00kPa生理盐水组。CO2和生理盐水灌注各组动物接受内镜甲状腺手术,分别在术前(T0),充气(充水)后45min(T1)、90min(T2)和放气(放水)后30min(T3)记录PaCO2、pH、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、Na+和HCT。结果:0.67kPaCO2组各项检测指标均无明显变化;1.33kPaCO2组在T1和T2时,PaCO2显著升高(P<0.01);2.00kPaCO2组在T1和T2时,PaCO2、pH和CVP显著变化(P<0.01),T3时上述参数仍高于基线水平(P<0.05)。生理盐水灌注各组在各时间点PaCO2、pH和Na+无明显变化,HCT有下降趋势,但差异无统计学意义(P>0.05)。1.33kPa生理盐水组在T2时,2.00kPa生理盐水组在T1和T2时,CVP显著升高(P<0.05)。各组HR和MAP在整个实验过程中变化不明显。结论:生理盐水灌注法不会引起高碳酸血症、酸中毒和稀释性低钠血症,在颈部内镜手术中可作为建立和维持手术空间的一种选择方法。

Objective：The study was aimed to inverstigate the effects of different levels of pressure and duration of carbon dioxide and saline in the neck of rabbits on metabolic, hemodynamic, serum sodium concentrations and hematocrit changes. Method：Twenty-one New Zealand rabbits were randomly divided into 7 groups according to the following pressure of CO2 or saline..0 kPa, 0.67 kPa CO2, 1.33 kPa CO2, 2.00 kPa CO2, 0.67 kPa saline, 1.33 kPa saline, and 2.00 kPa saline. In order to make a space for the endoscopic thyroidectomy, we filled the neck of rabbits with carbon dioxide and saline . Arterial partial pressure of CO2 （PaCO2）, pH, heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, serum sodium concentration and hematocrit were measured at baseline, 45 min and 90 min after filling with gas or saline and 30 min post-filling. Result：Insufflation of CO2 at 0.67 kPa did not have any significant effect on the parameters. PaCO2 increased significantly 45 min and 90 rain after insufflation of 1.33 kPa CO2 （P〈0.01）. Marked changes in PaCO2, pH and CVP occurred 45 rain and 90 min after insufflation of 2.00 kPa CO2 （P〈0.01）, and the parameters did not return to baseline in 30min after desufflation（P〈0.05）. In animals receiving saline irrigation no significant changes occurred in PaCO2, pH and serum sodium concentrations at any time point. There was a tendency of decrease in HCT, but no statistically significant changes were found （P〉0.05）. CVP increased significantly 90min after saline irrigation at 1.33 kPa（P 〈0.05）. A significant increase in CVP occurred 45 rain and 90 min after saline irrigation at 2.00 kPa（P〈0.05）. No significant changes in HR and MAP occurred in all animals. Conclusion：Filling with saline which does not cause hypercapnia, acidosis or dilutional hyponatremia can be used in endoscopic neck surgery to create and maintain a working space.