【摘要】 目的 研究不同压力二氧化碳（CO2）气腹对糖代谢的影响。 方法 18只雌性健康新西兰大白兔按CO2气腹压力随机均分为气腹压0 mm Hg （1 mm Hg=0.133 kPa）（Ⅰ组）、气腹压10 mm Hg（Ⅱ组）和气腹压15 mm Hg（Ⅲ组）。每组兔均在不同的压力下接受气腹1 h。在CO2气腹前（T0）、气腹后30 min （T1）、气腹后60 min （T2） 测定动脉血气分析值、血糖（Glu）、胰岛素（Ins）和胰高糖素（Gln）。 结果 气腹后30 min 、60 min，Ⅱ组与Ⅰ组比较，PaCO2、Glu 、Gln增加（Plt;0.05），pH值和Ins下降（Plt;0.05），Ⅲ组各参数变化更为显著（Plt;0.01）。结论 CO2气腹后机体可能处于较强烈的应激状态，导致血糖升高。【Abstract】 Objective To study effects of different intraabdominal pressure of carbon dioxide (CO2) pneumoperitoneum on blood glucose level in rabbits. Methods Eighteen female healthy rabbits weighed 2.1-3.3 kg were randomly divided into three groups equally based on pneumoperitoneum pressure: 0 mm Hg (1 mm Hg=0.133 kPa) group (groupⅠ),10 mm Hg group (groupⅡ) and 15 mm Hg (groupⅢ). Each group received 1h pneumoperitoneum under diffent pressure. Blood samples were taken before CO2 pneumoperitoneum, at 30 and 60 minutes after pneumoperitoneum for the measure-ments of arterial blood gas, blood glucose (Glu), insulin (Ins) and glucone (Gln). Results After pneumoperitoneum at 30 and 60 minutes, compared with groupⅠ, PaCO2,Glu and Gln were significantly raised in groupⅡ(Plt;0.05), pH and Ins were markedly decreased (Plt;0.05). Even more significant changes were observed in group Ⅲ(Plt;0.01). Conclusion After CO2 pneumoperitoneum, body is in a relatively b stress, so blood glucose is decreased.
With the extensive application of laparoscopy in clinical surgery, the advantages of laparoscopic surgery such as less intraoperative bleeding, small and beautiful incision, and rapid postoperative recovery become increasingly prominent. However, prolonged use of carbon dioxide (CO2) pneumoperitoneum or high CO2 pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia, in severe cases which may affect the quality of recovery and prognosis of patients. The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia, a mechanical ventilation model of controlled hyperventilation, can reduce or avoid the effects of hypercapnia caused by prolonged CO2 pneumoperitoneum or high CO2 pneumoperitoneum pressure. This article reviews the effects of laparoscopic CO2 pneumoperitoneum on patients, the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients. The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.