气腹对内毒素血症猪酸碱平衡和血流动力学的影响

Effects of pneumoperitoneum with CO_2 on hemodynamics and acid-base balance in endotoxemic pigs

目的 探讨气腹对内毒素血症猪酸碱平衡和血流动力学的影响。 方法 2 1只雄性家猪随机分为对照组 (A组 )、内毒素组 (B组 )和内毒素 +CO2 气腹组 (C组 ) ,每组 7只。实验在静脉吸入复合麻醉下进行。B组和C组经静脉给予内毒素 (2 μg·kg- 1 ·h- 1 )。 30min后C组给予CO2 建立气腹 ,压力 2 .0kPa。每 6 0min监测 1次各种指标并收集标本。气腹 3h后停止 ,继续观察2h后终止实验。 结果 内毒素的介入致B组和C组血浆内毒素显著高于A组 (P <0 .0 1) ,但B组和C组间差异无显著性意义 (P >0 .0 5 ) ;动脉血pH值 (apH)轻微降低 ,但与A组比较差异无显著性意义 (P >0 .0 5 )。气腹期间C组动脉血呈显著的混合型酸中毒改变。解除气腹后apH逐渐恢复至气腹前水平。B组较A组空肠黏膜pH值 (ipH)有轻度降低 ,但差异无显著性意义 (P >0 .0 5 ) ;气腹期间ipH显著降低 (P <0 .0 5 ) ,随着气腹时间的延长 ,ipH的下降也越来越显著 ,停止气腹后 ,ipH逐渐恢复。CO2 气腹导致平均动脉压 (MAP)、心输出量 (CO)下降 ,心率 (HR)、肺毛细血管楔压(PCWP)、平均肺动脉压 (MPAP)、门静脉压 (MPVP)增高 ,而对中心静脉压 (CVP)的影响不明显。 结论 在内毒素血症损害下 ,CO2 气腹对机体是非常危险的损伤因素 ,可致严重的休克。如处理?

Objective To investigate the effects of pneumoperitoneum with CO 2 on hemodynamics and acid base balance in endotoxemic pigs. Methods Twenty one male pigs were randomly and equally divided into three groups, ie, control group (Group A), endotoxin group (Group B), endotoxin and pneumoperitoneum with CO 2 group (Group C). The experiment was performed under the venous inhalation anesthesia. The pigs in the Groups B and C were injected with endotoxin intravenously (2 μg·kg 1 ·h 1 ). Thirty minutes later, a pneumoperitoneum was made through giving the Group C CO 2 (2.0 kPa). All the parameters should be monitored every 60 minutes and the samples collected. The pneumoperitoneum ended after 3 hours and the experiment did so after two hours of continuous monitoring. Results The interfered endotoxin caused the more significantly higher increase of plasma endotoxin in the Group B and the Group C than that in the Group A ( P < 0.01 ) but there was no significant difference between the Group B and the Group C ( P > 0.05 ). The pH of the arterial blood (apH) was decreased slightly without significant difference compared with the Group A. In the Group C, the arterial blood showed significant mixed acidosis during the pneumoperitoneum but the apH gradually recovered to the normal level posterior to the end of the pneumoperitoneum. Compared with the Group A, the pH of the jejunal mucosa (ipH) in the Group B decreased slightly without significant difference ( P > 0.05 ). During the pneumoperitoneum, the ipH was signifcantly decreased ( P < 0.05 ) and became more significant with time continuing, but it was recovered gradually after end of the pneumoperitoneum. The pneumoperitoneum with CO 2 caused the decrease of mean arterial pressure and cardiac output and the increase of heart rate, wedged pressure of pulmonary capillaries, mean pulmonary arterial pressure and portal vein pressure, but had insignificant effect on central venous pressure. Conclusions The pneumoperitoneum with CO 2 during endotoxemia has seriously damaged acid base balance and hemodynamics and even led to serious shock. Improper managements will enhance the risk of sepsis.