Effects Of CO₂ Pneumoperitoneum On MBF, PBF, CBF And Physiological Function In The Rabbit With Lung And Liver Impact Injury And Controlled Hemorrhage Shock

ObjectiveLaparoscopic indications become extensive with its technique development,but there are no unified theories whether or not laparoscopic techniques can be used in traumatic and shock patients,Furthermore fundamental research are deficiency.Our research intend to investigate MBF(myocardial blood flow),PBF(pulmonary blood flow),CBF(cerebral blood flow) and function changes of heart and pulmonary induced by different IAP(intraabdominal pressure) during CO2 pneumoperitoneum in the rabbit with traumatic liver and controlled hemorrhage shock, and hope to offer theoretical guides for using laparoscopic techniques in traumatic and shock patients.MethodsRabbits were randomized into nine groups limited by blood loss(6,12,22ml/kg)and intra-abdominal pressures(5,10,15mmHg).After model was established successfully,Items below were observed at time of pre-pneumoperitoneum(T0),0.5 hour under pneumoperitoneum(T1),2 hours under pneumoperitoneum(T2) and 0.5 hour after desufflation(T3) :1. Heart function,MBF and biochemical markers of myocardial injury:Cardiac output(CO),Left ventricle systolic pressure(LVSP),inferior vena pressure(IVP); MBF;Myohaemoglobin (Mb),cardiac troponin T (cTnT),lactate dehydrogenase (LDH) and MB isoenzyme activity of creatine kinase (CK-MB).2. PBF and parts of pulmonary function:PBF,respiration rate(RR) and ABG.3. CBF.Results1. Before insufflation LVSP decreased significantly in group of 22ml/kg blood loss(P<0.05);CO and MBF increased then got down(P<0.05) corresponding to the sequence of blood loss (6,12,22ml/kg);IVP did not change atypically(P>0.05). LDH,CK-MB,cTnT and Mb increased in 22ml/kg blood loss(P<0.05). PBF decreased corresponding to the sequence of blood loss (6,12,22ml/kg),RR and PaCO2 increased significantly(P<0.05); pH increased then got down(P<0.05); PaO2 and CBF decreased(P<0.05).2. Under 5mmHg IAP(intraabdominal pressure)(1) 6ml/kg blood loss: LVSP,MBF,CO,LDH,cTnT and CK-MB did not change significantly compared with no pneumoperitoneum(P>0.05), IVP,CBF increased then got down(P<0.05), Mb,PBF,RR and PaCO2 increased significantly(P<0.05), pH and PaO2 decreased significantly(P<0.05).(2) 12ml/kg blood loss: LVSP and RR did not change significantly compared with no pneumoperitoneum(P>0.05), IVP,LDH,cTnT,CK-MB,Mb and PaCO2 increased significantly (P<0.05), MBF,CO,CBF and PBF increased then got down(P<0.05),pH and PaO2 decreased significantly(P<0.05).(3) 22ml/kg blood loss: LDH,cTnT,CK-MB and Mb increased significantly compared with no pneumoperitoneum(P<0.05),other items could not calculate because of high death rates.3. Under 10mmHg IAP(1) 6ml/kg blood loss: LVSP increased then got down compared with no pneumoperitoneum (P<0.05), IVP, MBF,CO,LDH,CBF,PBF,PaCO2,cTnT,RR and Mb increased significantly (P<0.05),CK-MB did not change significantly(P>0.05), pH and PaO2 decreased significantly(P<0.05).(2) 12ml/kg blood loss: LVSP, MBF,CO,PBF,pH,PaO2 and CBF decreased significantly compared with no pneumoperitoneum(P<0.05),IVP,LDH,PaCO2,cTnT,RR,CK-MB and Mb increased significantly(P<0.05).(3) 22ml/kg blood loss: LDH,cTnT,CK-MB and Mb increased significantly compared with no pneumoperitoneum(P<0.05),other items could not calculate because of high death rates.4. Under 15mmHg IAP(1) 6ml/kg blood loss: LVSP, MBF,CO,PBF pH,PaO2 and CBF decreased significantly compared with no pneumoperitoneum(P<0.05),IVP,LDH,PaCO2,cTnT, RR,CK-MB and Mb increased significantly(P<0.05). (2) 12ml/kg blood loss: LVSP, MBF,CO,PBF pH,PaO2 and CBF decreased significantly compared with no pneumoperitoneum(P<0.05).IVP,LDH,PaCO2,cTnT, CK-MB and Mb increased significantly(P<0.05),RR did not change significantly(P>0.05).(3) 22ml/kg blood loss: LDH,cTnT,CK-MB and Mb increased significantly compared with no pneumoperitoneum(P<0.05),other items could not calculate because of high death rates.5. After desufflationPart of items recovered in 5,10mmHg IAP which were still alive,but IVP,MBF,CO,PBF,pH and CBF in 12ml/kg blood loss could not reach the baseline completely(P<0.05).Conclusions1. Under 5mmHg CO2 pneumoperitoneum pressure:there are no significant effects to heart hemodynamics,heart function,PBF,pulmonary function and CBF of rabbits in lung-liver impact injury and light controlled hemorrhage shock with no resuscitation;In medium controlled hemorrhage shock(12ml/kg),MBF,PBF and CBF may increase firstly,then decrease;In severe controlled hemorrhage shock(22ml/kg),all decrease with high death rate.2. Under 10mmHg CO2 pneumoperitoneum pressure:MBF,PBF and CBF of rabbits in lung-liver impact injury and light controlled hemorrhage shock with no resuscitation may increase firstly,then decrease;In medium or severe controlled hemorrhage shock (12,22ml/kg),all decrease with high death rate,maybe intend to heart and pulmonary disfunction.3. Under 15mmHg CO2 pneumoperitoneum pressure:MBF,PBF and CBF may decrease with high death rate, severe dysfunction of heart and pulmonary appears,which of rabbits with lung-liver impact injury and light,medium or severe controlled hemorrhage shock(6,12,22ml/kg) with no resuscitation.4. From the experiment,we found that there may helpful with low CO2 pneumoperitoneum pressure when laparoscope used in patients under trauma and hemorrhagic shock condition,and there should be careful under no resuscitation when using laparoscope.