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首页> 外文期刊>Surgical Endoscopy >Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial
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Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial

机译：腹腔镜结直肠手术期间较低的腹腔压力没有心肺益处：双盲，随机对照试验

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BackgroundHigher intra-abdominal pressure may impair cardiopulmonary functions during laparoscopic surgery. While 12-15mmHg is generally recommended as a standard pressure, the benefits of lower intra-abdominal pressure are unclear. We thus studied whether the low intra-abdominal pressure compared with the standard pressure improves cardiopulmonary dynamics during laparoscopic surgery.MethodsPatients were randomized according to the intra-abdominal pressure and neuromuscular blocking levels during laparoscopic colorectal surgery: low pressure (8mmHg) with deep-block (post-tetanic count 1-2), standard pressure (12mmHg) with deep-block, and standard pressure with moderate-block (train-of-four count 1-2) groups. During the laparoscopic procedure, we recorded cardiopulmonary variables including cardiac index, pulmonary compliance, and surgical conditions. We also assessed postoperative pain intensity and recovery time of bowel movement. The primary outcome was the cardiac index 30min after onset of laparoscopy.ResultsPatients were included in the low pressure with deep-block (n=44), standard pressure with deep-block (n=44), and standard pressure with moderate-block (n=43) groups. The mean (SD) of cardiac index 30min after laparoscopy was 2.7 (0.7), 2.7 (0.9), and 2.6 (1.0) Lmin(-1)m(-2) in each group (P=0.715). The pulmonary compliance was higher but the surgical condition was poorer in the low intra-abdominal pressure than the standard pressure (both P0.001). Other variables were comparable between groups.ConclusionWe observed few cardiopulmonary benefits but poor surgical conditions in the low intra-abdominal pressure during laparoscopy. Considering cardiopulmonary dynamics and surgical conditions, the standard intra-abdominal pressure may be preferable to the low pressure for laparoscopic surgery.
机译：背景高压腹腔压力可能在腹腔镜手术期间损害心肺功能。虽然通常推荐12-15mmHg作为标准压力，但腹腔内压力较低的益处尚不清楚。因此，我们研究了与标准压力的腹腔内压力低低内腹腔内压力是否改善了腹腔镜手术期间的心肺动力学。根据腹腔镜结肠直肠手术内的腹腔内压力和神经肌肉阻断水平随机化：低压（8mmHg），深层压力（Tetanic Count 1-2），具有深层压力（12mmHg）的标准压力（12mmHg），以及中等块（四阵乘坐四个计数1-2）组的标准压力。在腹腔镜程序期间，我们记录了心肺变量，包括心脏指数，肺顺应性和手术条件。我们还评估了术后疼痛强度和肠道运动的恢复时间。主要结果是腹腔镜检查后的心脏指数30分钟。腹腔镜术后，含有深层（n = 44）的低压，具有深层（n = 44）的标准压力，和中等阻力（ n = 43）组。腹腔镜检查后心脏指数30min的平均值（SD）为2.7（0.7），2.7（0.9）和2.6（1.0）Lmin（-1）m（-2）（P = 0.715）。肺顺应性较高，但在腹内压力的低腹腔内的手术条件较差，而不是标准压力（P <0.001）。其他变量在组之间是可比的。结论我们在腹腔镜检查期间观察到少数心肺益处，但在腹腔镜的低内腹部压力下差。考虑心肺动力学和手术条件，对腹腔镜手术的低压可能优于腹腔内压力的标准压力。

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