中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2011年
1期
53-56
,共4页
气腹,人工%二氧化碳%氧化亚氮%猪%心血管系统
氣腹,人工%二氧化碳%氧化亞氮%豬%心血管繫統
기복,인공%이양화탄%양화아담%저%심혈관계통
Pneumoperitoneum,artificial%Carbon dioxide%Nitrous oxide%Swine%Cardiovascular system
目的 建立新生猪气腹及心功能不全模型,观察长时间CO2及N2O气腹时心功能不全新生猪血流动力学指标的变化规律,比较膨腹气体对有合并症的新生机体进行长时间充填时的优劣.方法 乳猪14头,年龄7～14 d,体重2～4 kg.分为2组,心功能不全CO2气腹组(CO2-HF)7头,心功能不全N2O气腹组(N2O-HF)7头.CO2-HF及N2O-HF组进行4 h气腹,监测时间点为麻醉稳定后气腹开始前5 min,气腹开始后15、60、120、180、240 min,放气后30min.监测指标为:心率(HR)、每搏输出量指数(SVI)、心输出量指数(CI)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、系统血管阻力指数(SVRI)、左室内压变化速率(dP/dtmax).结果 与成模前相比,两组成模时HR、SVI及CI降低,差异有统计学意义(P＜0.05);MPAP升高及SVRI增加,差异有统计学意义(P＜0.05);dP/dtmax、MAP及CVP无明显改变.随后两组HR无明显改变,两组CI继续下降,两组MPAP继续升高,两组CVP升高,差异有统计学意义(P＜0.05).CO2-HF组MAP及dP/dtmax下降、SVI继续降低,SVRI继续增加,差异具有统计学差异(P＜0.05).结论 心功能不全新生猪进行长时间气体充填时CO2气腹对心功能影响明显,导致心肌收缩力明显下降及系统血管阻力明显增加;心功能不全新生猪进行长时间N2O气腹充填时心功能无进一步下降趋势.
目的 建立新生豬氣腹及心功能不全模型,觀察長時間CO2及N2O氣腹時心功能不全新生豬血流動力學指標的變化規律,比較膨腹氣體對有閤併癥的新生機體進行長時間充填時的優劣.方法 乳豬14頭,年齡7～14 d,體重2～4 kg.分為2組,心功能不全CO2氣腹組(CO2-HF)7頭,心功能不全N2O氣腹組(N2O-HF)7頭.CO2-HF及N2O-HF組進行4 h氣腹,鑑測時間點為痳醉穩定後氣腹開始前5 min,氣腹開始後15、60、120、180、240 min,放氣後30min.鑑測指標為:心率(HR)、每搏輸齣量指數(SVI)、心輸齣量指數(CI)、平均動脈壓(MAP)、中心靜脈壓(CVP)、平均肺動脈壓(MPAP)、繫統血管阻力指數(SVRI)、左室內壓變化速率(dP/dtmax).結果 與成模前相比,兩組成模時HR、SVI及CI降低,差異有統計學意義(P＜0.05);MPAP升高及SVRI增加,差異有統計學意義(P＜0.05);dP/dtmax、MAP及CVP無明顯改變.隨後兩組HR無明顯改變,兩組CI繼續下降,兩組MPAP繼續升高,兩組CVP升高,差異有統計學意義(P＜0.05).CO2-HF組MAP及dP/dtmax下降、SVI繼續降低,SVRI繼續增加,差異具有統計學差異(P＜0.05).結論 心功能不全新生豬進行長時間氣體充填時CO2氣腹對心功能影響明顯,導緻心肌收縮力明顯下降及繫統血管阻力明顯增加;心功能不全新生豬進行長時間N2O氣腹充填時心功能無進一步下降趨勢.
목적 건립신생저기복급심공능불전모형,관찰장시간CO2급N2O기복시심공능불전신생저혈류동역학지표적변화규률,비교팽복기체대유합병증적신생궤체진행장시간충전시적우렬.방법 유저14두,년령7～14 d,체중2～4 kg.분위2조,심공능불전CO2기복조(CO2-HF)7두,심공능불전N2O기복조(N2O-HF)7두.CO2-HF급N2O-HF조진행4 h기복,감측시간점위마취은정후기복개시전5 min,기복개시후15、60、120、180、240 min,방기후30min.감측지표위:심솔(HR)、매박수출량지수(SVI)、심수출량지수(CI)、평균동맥압(MAP)、중심정맥압(CVP)、평균폐동맥압(MPAP)、계통혈관조력지수(SVRI)、좌실내압변화속솔(dP/dtmax).결과 여성모전상비,량조성모시HR、SVI급CI강저,차이유통계학의의(P＜0.05);MPAP승고급SVRI증가,차이유통계학의의(P＜0.05);dP/dtmax、MAP급CVP무명현개변.수후량조HR무명현개변,량조CI계속하강,량조MPAP계속승고,량조CVP승고,차이유통계학의의(P＜0.05).CO2-HF조MAP급dP/dtmax하강、SVI계속강저,SVRI계속증가,차이구유통계학차이(P＜0.05).결론 심공능불전신생저진행장시간기체충전시CO2기복대심공능영향명현,도치심기수축력명현하강급계통혈관조력명현증가;심공능불전신생저진행장시간N2O기복충전시심공능무진일보하강추세.
Objective This experiment established a pneumoperitoneum model and acute cardiac failure model in piglets. It studies changes of hemodynamics of extended artificial pneumoperitoneum with CO2 and N2O in piglets with cardiac dysfunction. Methods Fourteen piglets (2-4 kilogram in weight,7-14 days of age) were divided into two groups: cardiac failure & CO2 group (CO2-HF) and cardiac failure & N2O group (N2O-HF). Both group underwent 4 hours of pneumoperitoneum. Measurements were carried out 5min before anaesthesia, 15,60,120, 180,240 min after establishing pneumoperitoneum and 30 min after deflation. Investigation included heart rete, stroke volume index, cardiac index, mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, systemic vascular resistance index and dP/dtmax. Results In CO2-HF and N2O-HF groups,compared to the preoperative baseline, HR, SVI and CI decreased (P＜0. 05 ), while MPAP and SVRI increased (P＜0. 05). There was no statistical alteration in dP/dtmax, MAP and CVP. Post-operatively, HR were stable in both groups, CI decreased further, MPAP increased further and CVP increased(P＜0. 05). In CO2-HF group, MAP and dP/dtmax decreased,SVI decreased further and SVRI increased further(P＜0. 05). Conclusions Cardiac contractility decreased and systemic vascular resistance index increased significantly during extended CO2 pneumoperitoneum in piglets with compromised heart function. There was no deterioration of heart function with extended N2O pneumoperitoneum in piglets with heart failure.
