腹腔镜手术对心功能影响的动物实验研究

Influence of laparoscopic surgery on cardiac function(An animal study)

目的 探讨腹腔镜手术中的腹压增高导致的心功能及血液动力学的变化。方法 用腹腔内快速注入空气的方法制造 7头乳猪急性腹压增高的模型。在腹压为基础值 7.5、15及 30mmHg时分别测量心输出量 ,左、右心房压 ,腹部下腔静脉压及心包压。结果 心输出量在轻度腹压增高时增加 ,当腹压超过 15mmHg时下降。腹压轻度增高时右心房压与下腔静脉压平行增高 ,而超过 15mmHg时 ,右心房压与下腔静脉压呈分离变化 ,右心房压停止增高。左心房透壁压和右心房透壁压与心输出量之间的变化关系明显不同。结论 腹腔镜手术中的腹压增高导致的心功能变化是一个复杂过程 ,不仅与气腹压力的大小有关 。

Objective To study the cardiac performance and hemodynamic change under laparoscopic surgery.Methods Seven piglets were acutely instrumented with pneumoperitoneum (PP) by air insufflation. Cardiac output(CO),pressure of left atrial(Pla),right atrial(Pra),pericardiac(Ppe) and abdominal inferior vena cava(Pivc) were measured while abdominal pressure(Pab) was increased from baseline to 7.5 ,15,and 30?mmHg.Results CO presented biphasic changes,with an initial slight increase at PP 7.5 followed by a fall when PP15?mmHg. A significant discrepancy was observed between Pra and Pivc at PP15 and PP30?mmHg. In contrast to significant increase of Pivc,Pra hardly increased with Pab when PP> 7.5 ?mmHg. Transmural Pla(Pla Ppe) showed parallel changes with CO,whereas transmural Pra(Pra Ppe) presented a sustained increase.Conclusions The change of cardiac function,response to increased abdominal pressure produced by laparoscopic surgery,exhibited a complex procedure and it's determined by not only severity of Pab but also other factors like hemodynamic conditions.