兔颈部生理盐水灌注内镜甲状腺手术

目的在兔颈部皮下灌注生理盐水以营造手术空间完成甲状腺切除术。检测不同生理盐水灌注压力和持续时间对代谢、血流动力学参数、血浆Na 、红细胞压积(hematocrit,HCT)以及颅内压(intracranial pres-sure,ICP)的影响,旨在评估内镜甲状腺手术术腔灌注生理盐水的可行性和安全性。方法根据颈部灌注液体的压力,将12只新西兰兔随机分成4组,分别为颈部不充介质对照组、5mmHg生理盐水组、10mmHg生理盐水组和15mmHg生理盐水组。生理盐水灌注各组动物接受内镜甲状腺切除术,分别在术前(T0),充水后45min(T1)、90min(T2)和放水后30min(T3)记录PaCO2、pH、HR、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、Na 、HCT和ICP。结果生理盐水灌注各组在各时间点PaCO2、pH、HR、MAP和Na 无明显变化,HCT有下降趋势,但差异无统计学意义(P>0.05)。10mmHg生理盐水组在T2时,15mmHg生理盐水组在T1和T2时,CVP显著升高(P<0.05)。15mmHg生理盐水组在T1和T2时ICP显著升高(P<0.01)。结论内镜甲状腺手术中颈部灌注生理盐水可避免高碳酸血症、酸中毒和稀释性低钠血症的风险。临床上推荐将灌注压力控制在10mmHg以下。

Endoscopic thyroidectomy with saline irrigation in a rabbit model

Purpose Endoscopic thyroidectomy was performed in rabbits with saline irrigation in the neck.The effects of different levels of irrigation pressure and duration on metabolic,hemodynamic,serum sodium concentrations,hematocrit(HCT) and intracranial pressure(ICP) changes were investigated in order to evaluate the feasibility and safety of saline irrigation during endoscopic thyroid surgery.Methods According to the irrigation pressure in the neck,12 New Zealand rabbits were randomly divided into 4 groups:0 mmHg,5 mmHg saline,10 mmHg saline,and 15 mmHg saline.Animals receiving saline irrigation underwent endoscopic thyroidectomy.Arterial partial pressure of CO2(PaCO2),pH,heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),serum sodium concentrations,HCT and ICP were measured at baseline,45 min and 90 min after saline irrigation,and 30 min post-irrigation.Results Irrigation of saline did not have any significant effect on PaCO2,pH,HR,MAP and serum sodium concentrations at any time point.There was a tendency of decrease in HCT,but no statistically significant changes were found(P>0.05).CVP increased significantly 90 min after saline irrigation at 10 mmHg(P<0.05).A significant increase in CVP occurred 45 min and 90 min after saline irrigation at 15 mmHg(P<0.05).ICP elevated significantly 45 min and 90 min after saline irrigation at 15 mmHg(P<0.01).Conclusions The use of saline irrigation for endoscopic thyroidectmy avoids the risk of hypercapnia,acidosis and dilutional hyponatremia.Irrigation pressure up to 10 mmHg is recommended for clinical application.