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首页> 外文期刊>Surgical Endoscopy >Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum.
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Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum.

机译：不同方法的系统评估，以最小化气腹过程中的血液动力学变化。

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BACKGROUND: Capnoperitoneum (CP) compromises hemodynamic function during laparoscopy. Three therapeutic concepts were evaluated with an aim to minimize the hemodynamic reaction to CP: First, a controlled increase of intrathoracic blood volume (ITBV) by intravenous fluids; second, partially reduced sympathetic activity by the beta1-blocker esmolol; and third, a decrease in mean arterial pressure (MAP) by the vasodilator sodium nitroprusside. METHODS: For this study, 43 pigs were assigned to treatment with fluid and sodium nitroprusside (group A) or with esmolol (group B). In both groups, the pigs were assigned to head-up, head-down, or supine position, resulting in three different subgroups. Invasive hemodynamic monitoring was established including left heart catheter and cardiac oxygen lung water determination (COLD) measurements. Measurements were documented before CP with the animals in supine position, after induction of a 14-mmHg CP with the animals in each body position, after a 10% reduction in MAP by vasodilation, and after an increase in ITBV of about 30% by infusion of 6% hydroxyethylstarch solution. RESULTS: Increasing ITBV improved hemodynamic function in all body positions during CP. Esmolol reduced cardiac output and myocardial contractility. Sodium nitroprusside did not improve hemodynamic function in any body position. CONCLUSIONS: Optimizing volume load is effective for minimizing hemodynamic changes during CP in the head-up and in head-down positions. In general, beta(1)-blockers cannot be recommended because they might additionally compromise myocardial contractility and suppress compensatory reaction of the sympathetic nerve system. Vasodilation has not improved hemodynamic parameters during CP.
机译：背景：腹膜腔镜（CP）会在腹腔镜检查期间损害血液动力学功能。为了使对CP的血液动力学反应减至最小，评估了三种治疗方案：首先，通过静脉输液控制胸腔内血容量（ITBV）的增加;第二，β1-受体阻滞剂艾司洛尔部分降低了交感神经活动;第三，血管扩张剂硝普钠降低平均动脉压（MAP）。方法：对于本研究，将43头猪接受液体和硝普钠（A组）或艾司洛尔（B组）的治疗。在这两个组中，将猪分头朝上，头朝下或仰卧，从而形成三个不同的亚组。建立了侵入性血流动力学监测，包括左心导管和心脏氧肺水测定（COLD）测量。在将动物置于仰卧位的CP之前，在使动物处于每个体位的CP诱导14 mmHg的CP，通过血管舒张使MAP降低10％之后以及通过输注使ITBV升高约30％之后，记录测量结果6％羟乙基淀粉溶液。结果：在CP期间增加ITBV可改善所有身体部位的血液动力学功能。艾司洛尔降低心输出量和心肌收缩力。硝普钠不能改善任何身体位置的血液动力学功能。结论：优化容积负荷可有效减少CP在抬头和抬头位置时的血液动力学变化。通常，不建议使用β（1）受体阻滞剂，因为它们可能会进一步损害心肌收缩力并抑制交感神经系统的代偿反应。在CP期间，血管舒张并未改善血液动力学参数。

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