Evaluation of Hemodynamic Changes Using Different Intra-Abdominal Pressures for Laparoscopic Cholecystectomy

Biliary diseases known since ages constitute major portion of digestive tract disorders world over. Among these cholelithiasis being the fore runner causing general ill health, thereby requiring surgical intervention for total cure. The study was undertaken in an attempt to compare the hemodynamic changes in patient undergoing laparoscopic cholecystectomy using different intra-abdominal pressures created due to carbon dioxide insufflation. The patients were randomly allocated to one of the three groups in which different levels of intra-abdominal pressures (8–10 mmHg,11–13 mmHg and 14 mmHg and above) were maintained. The base line parameters monitored were heart rate, non invasive blood pressur(systolic and mean)and end tidal carbon dioxide. All the parameters were monitored at various intervals i.e. Immediately during insufflation, 5 min, 10 min, 20 min, 30 min after CO2 insufflation and after every 10 min if surgery exceeds 30 min, at exsufflation,10 min after CO2 exsufflation. Patients were ventilated with Pedius Drager Ventilator keeping tidal volume 8–10 ml/kg and respiratory rate 12–14 breaths/min. During surgery patients were placed in reverse Trendlenburg position (head up) at 15 °. The results obtained were evaluated statistically and analyzed. Baseline characteristics were found to be comparable. Hemodynamic variables were reported as mean and standard deviation. Statistical significance among groups was evaluated using Analysis of Variance and unpaired student t test (two tailed). Inter-group comparisons were made using Bonferroni test. A p-value of <0.05 was considered as statistically significant. In all the three groups the mean heart rate (baseline 84.08 ± 12.50, 87.96 ± 15.73 and 86.92 ± 17.00 respectively) increased during CO2 insufflation and the rise in heart rate continued till exsufflation after which it decreased and at 10 min after exsufflation the heart rates were comparable with the baseline. The inter-group comparison of mean heart rate between I & III was statistically significant at 10, 20, 30 min after CO2 insufflation which continued at exsufflation and 10 min after CO2 exsufflation [p < 0.05]. The inter-group comparison between I & III showed statistically significant difference in systolic blood pressure at 10, 20, 30 min after CO2 insufflation, at exsufflation and 10 min after exsufflation [p = 0.0001] and mean arterial pressure at 5, 10, 20, 30 min after CO2 insufflation, at exsufflation and 10 min after exsufflation [p = 0.0001]. Comparison between Group I and Group III & between Group II and Group III showed highly significant statistical difference in EtCO2 immediately after insufflation and the same trend was seen till the completion of surgery and even 10 min after exsufflation [p = 0.001]. The conclusion drawn from the study was that laparoscopic cholecystectomy induces significant hemodynamic changes intraoperatively, the majority of pathophysiological changes are related to cardiovascular system and are caused by CO2 insufflation .A high intra-abdominal pressure due to CO2 insufflation is associated with more fluctuations in hemodynamic parameters and increased peritoneal absorption of CO2 as compared to low intraabdominal pressure so low pressure pneumoperitoneum is feasible for laparoscopic cholecystectomy and minimizes the adverse hemodynamic effects of CO2 insufflation.

Electronic supplementary material

The online version of this article (doi:10.1007/s12262-012-0484-x) contains supplementary material, which is available to authorized users.     

嗜铬细胞瘤围手术期血压变化的影响因素分析

目的 分析引起嗜铬细胞瘤围手术期血压波动的影响因素,探讨改善其血流动力学的措施.方法 对2000-2010年收治的经手术治疗的嗜铬细胞瘤患者的临床资料进行回顾性研究.采用Pearson相关分析和多元Logistic回归等统计学方法对影响围手术期血压波动的因素进行分析.结果 Pearson相关分析显示术中收缩压的最大波动值(△SBP)的影响因素包括术前最高收缩压(r=0.196,P=0.013)、术前24h尿肾上腺素含量(r=0.207,P=0.008)及术中失血量(r=0.253,P=0.003).多元Logistic回归分析显示影响术后顽固性低血压的因素包括24h尿去甲肾上腺素(OR=1.273,P=0.002)、术前准备时间(OR=0.921,P=0.034);术后高血压的危险因素有肿瘤残留(OR=16.920,P=0.001)、术前红细胞压积变化(OR=1.467,P=0.018).结论 尽管经过充分的术前准备,嗜铬细胞瘤患者围手术期仍可发生较大的血压波动.嗜铬细胞瘤围手术期的血压波动受到多种因素影响,针对这些影响因素采取措施,可减少血压的波动,从而减少手术风险.     

不同起搏频率对清醒狗血流动力学的影响

本文在7条清醒狗上观察不同起搏频率时安静和自由活动状态下血流动力学的变化。结果表明,按需型起搏器的起搏频率最好选用正常状态下24小时的平均心率(90次/分),因为此时24小时平均动脉压和心房率的平均值都接近于正常时的数值。与一般常用的起搏频率(75次/分)相比,还具有提高心脏储备能力的优点,能减少活动时增加每搏输出量的负担,而且,心房率相对减少可以减少房室同时收缩而引起起搏综合征的可能性。     

多层螺旋CT灌注成像在儿童肝脏肿瘤中的应用分析

目的:探讨多层螺旋CT灌注成像对儿童肝脏肿瘤的诊断价值。方法:回顾性分析32例经病理证实的儿童肝脏肿瘤的多层螺旋CT灌注表现,其中男18例,女14例,年龄15天～12岁,分析肝脏肿瘤病变的灌注参数及血运改变情况。结果:肝恶性肿瘤组病灶中心HAI均明显高于病灶边缘,高于正常肝组织,肝良性肿瘤组病灶中心HAI与正常肝组织一致。在良、恶性肿瘤的鉴别诊断方面肝动脉灌注指数(HAI)具有重要的价值。结论:多层螺旋CT灌注成像是可以提供一种准确且相对简洁的评价儿童肝脏肿瘤的范围及性质的方法。     

儿童疫苗接种常见不良反应及处理

疫苗接种是消除感染性疾病的重要措施。然而,疫苗接种不可避免地会引起各种不良反应,需引起儿科医师重视并给予及时适当处理。临床医生应了解儿童疫苗接种不良反应常见临床类型（疫苗接种后一般反应、异常反应、疫苗接种后现象等）及基本处理方法。     

小型猪静脉增流DIEP皮瓣的血流动力学研究

目的 研究静脉增流对小型猪腹壁下动脉穿支(DIEP)皮瓣成活面积的影响及其血流动力学特点。方法 选取24头小型猪,在其腹部形成模拟增流DIEP皮瓣和传统DIEP皮瓣,并进行相应指标测量。包括皮瓣的血流灌注,静脉血管的压力,以及静脉血气分析。血流动力学测量后,所有腹部皮瓣原位缝合,随机选取12只形成静脉增流的DIEP皮瓣(实验组),其余12只为传统的DIEP皮瓣(对照组)。术后7 d进行活检,测量皮瓣的成活面积。结果 在静脉增流模式下,各血流动力学指标均较无增流情况下明显改善。对照组皮瓣成活率为(82.1±7.6)%,实验组为(99.4士1.2)%,差异显著。结论静脉增流技术可显著改善DIEP皮瓣灌注并增加皮瓣成活面积。就大面积皮瓣而言,静脉增流技术是改善静脉淤血和增大皮瓣成活面积的可靠方式。     

Evaluation of Anthropogenic Substrate Variability Based on Non-Destructive Testing of Ground Anchors

The purpose of this paper is to describe the variability of soil rheological properties based on research carried out using load tests of ground anchors under complex geotechnical conditions. The heterogeneity of soil should always be considered when designing geotechnical constructions. In the present case, the earthwork created at the Warsaw Slope revealed an embankment of anthropogenic origin, located in a geologically and geomorphologically complex area of the Vistula valley slope. Excavation protection was anchored mainly in soils of anthropogenic origin. When the acceptance tests of the ground anchor were completed, the subsoil randomness was confirmed using nondirect, geostatistical methods. A standard solid rheological model with nonlinear fitting to the data was used. This model was established to describe the creeping activity of the ground anchor more accurately. The characteristics of man-made embankments were described using the parameters obtained with the rheological model of the subsoil.     

猪髂总动脉狭窄对腹主动脉下段及同侧髂总动脉狭窄上游血流动力学的影响

目的：探讨髂总动脉不同程度狭窄引起腹主动脉下段及同侧髂总动脉狭窄上游血流动力学变化的差异。方法：幼年家猪6只,利用血管夹夹闭髂总动脉侧壁依次造成1/4、1/2、3/4管腔狭窄,记录对应腹主动脉下段及同侧髂总动脉狭窄上游血流流速曲线,测算PSV、MDV。分析所有实验数据并进行统计学处理,观察血流参数与狭窄程度的相关性,并比较髂总动脉不同程度狭窄引起腹主动脉下段及同侧髂总动脉狭窄上游血流动力学变化的差异。结果：PSV与狭窄程度呈线性负相关,MDV随狭窄程度的增加呈负性增加,髂总动脉狭窄上游血流动力学改变较腹主动脉下段显著。狭窄达到一定程度后,同侧髂总动脉狭窄上游出现针尖状反向血流流速曲线,并随狭窄程度的加重而增高。结论：狭窄上游不同部位血流动力学的改变不同,离狭窄越近处变化越显著,针尖状反向血流流速曲线的出现说明靠近狭窄部位。