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The effects of pneumoperitoneum on gastric blood flow and traditional hemodynamic measurements (see comments)

机译：气腹对胃血流量和传统血流动力学测量的影响（见评论）

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BACKGROUND: The purpose of this study was to investigate the effects of increasing intraabdominal pressure (IP) on gastric blood flow, as measured by gastric tonometry and traditional hemodynamic measurements. METHODS: Nine swine were anesthetized, intubated, and ventilated. Arterial and pulmonary artery catheters were placed by cutdown, a trocar was placed in the abdomen, and a gastric tonometer was placed in the stomach. Serial measurements of arterial and mixed venous blood gases, cardiac output, wedge pressure, lactic acid, and gastric intramucosal pH (pHi) were collected at intraperitoneal pressures of 0, 8, 10, 12, 14, 16, and 18 mm Hg after 30 min equilibration. Statistical analysis included Pearson correlation and Student's t test. RESULTS: Increasing levels of IP were correlated with decreased arterial pH (p < 0.00003), increased mixed venous CO2 (p < 0.003), decreased intramucosal pH (p < 0.014), and increased arterial CO2 (p < 0.015). Gastric pHi differed significantly from baseline at IP levels of 16 mm Hg (p < 0.004) and 18 mm Hg (p < 0.01). No significant effects were observed on cardiac output or arterial lactate. No significant effects were observed in a control group that had been insufflated to 8 mm Hg and held constant over 3 h. CONCLUSIONS: In this model, gastric blood flow is adversely affected by increasing i.p. with pronounced effects in excess of 15 mm Hg. These results suggest that gastric tonometry may be used to monitor the adverse effects of pneumoperitoneum. Gastric pHi may be an earlier indicator of altered hemodynamic function during laparoscopy than traditional measures.
机译：背景：本研究的目的是研究通过腹膜张力计和传统血流动力学测量来测量腹腔内压力（IP）升高对胃血流的影响。方法：对9头猪进行麻醉，插管和通气。通过切除术放置动脉和肺动脉导管，在腹部放置套管针，并在胃放置胃压计。 30分钟后，在腹膜内压力分别为0、8、10、12、14、16和18 mm Hg的情况下，收集动脉和混合静脉血气，心输出量，楔形压力，乳酸和胃黏膜内pH（pHi）的系列测量值。最小平衡。统计分析包括Pearson相关性和Student t检验。结果：IP水平升高与动脉pH降低（p <0.00003），混合静脉CO2升高（p <0.003），粘膜内pH降低（p <0.014）和动脉CO2升高（p <0.015）相关。在IP浓度为16 mm Hg（p <0.004）和18 mm Hg（p <0.01）时，胃pHi与基线显着不同。没有观察到对心输出量或动脉血乳酸的显着影响。在吹入8毫米汞柱并在3小时内保持恒定的对照组中，未观察到明显的影响。结论：在该模型中，腹腔内压力增加对胃血流量产生不利影响。效果超过15毫米汞柱。这些结果表明，胃压计可用于监测气腹的不良反应。胃pHi可能是腹腔镜检查期间血流动力学功能改变的早期指标，较之传统措施更早。

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