失血性休克复苏后CO_2气腹对兔肝、肾和心功能的影响
|
摘要
目的
近年来，腔镜技术由于其各种优点在外科领域应用日益广泛。而失血性休克复苏后行腹腔镜手术时COB2B气腹对机体影响的基础性研究还很少。我们前期的研究提示：中度及重度创伤失血性休克未复苏情况下建立COB2B气腹，当气腹压力为10 mmHg和15mmHg时实验动物死亡率高，且较高腹内压、长时间气腹对实验动物心、肺、脑血流量及生理功能影响较大。本课题通过建立失血性休克复苏兔模型，旨在探讨在循环血流量减少复苏情况下COB2B气腹对肝、肾和心肌血流量及功能的影响，以期为腔镜技术在创伤失血性休克患者的应用进一步提供理论依据。
方法
根据休克程度[中度休克(失血量20％～40％)和重度休克(失血量>40％) ]和气腹压力(5 mmHg，10 mmHg和15 mmHg)将实验动物随机分为6组(中度休克/5 mmHg，中度休克/10 mmHg，中度休克/15 mmHg，重度休克/5 mmHg，重度休克/10 mmHg，重度休克/15 mmHg)，若有死亡则补充，保证每组有效数量8只。制作失血性休克复苏兔模型，分别于气腹前、气腹0.5 h、气腹2 h以及撤去气腹后0.5 h四个时相点检测以下指标：
1.谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、肌酐(serum creatinine,Cr)和尿素氮(Blood urea nitrogen,BUN)用全自动生化仪进行指标检测；乳酸脱氢酶(lactic dehydrogenase,LDH)、肌酸激酶同工酶MB(isoenzyme activity of creatine kinase,CK-MB)和肌钙蛋白(cardiac troponin T,cTnT)则用试剂盒进行检测。
2.肝血流量(hepatic blood flow, HBF)、肾血流量(the blood flow of renal, RBF)和心肌血流量(myocardial blood flow，MBF)用彩色微球法检测。
结果
1.肝功能(1)AST：COB2B气腹前和撤去气腹后：AST与失血量呈正比。气腹后：气腹0.5 h时AST即明显升高(P<0.05),重度休克组同中度休克组相比有显著性差异(P<0.05)。(2)ALT：COB2B气腹前和撤去气腹后：重度休克组较中度休克组的ALT上升显著(P<0.05)。气腹后：中度休克、5 mmHg气腹压时，气腹2 h时ALT才显著增加，气腹压增加至10 mmHg，气腹0.5 h时即明显上升(P<0.05)；重度休克组较中度休克组ALT升高显著，组间比较也有显著性差异(P<0.05)。(3)HBF：COB2B气腹前和撤去气腹后：HBF随失血量的增加而减少。气腹后：5 mmHg和10 mmHg气腹时，中度休克组HBF 2h时才明显下降(P<0.05)；而15 mmHg气腹时，0.5 h即显著减少(P<0.05)；重度休克组气腹0.5 h HBF即明显减少，与中度休克组比较下降明显，且组内比较也有显著性差异(P<0.05)。
2.肾功能(1)Cr：COB2B气腹前和撤去气腹后：重度休克组较中度休克组的Cr上升。气腹后：中度休克、5 mmHg气腹压时，气腹2 h时Cr才显著增加，气腹压增加至10mmHg，气腹0.5 h时即明显上升(P<0.05)；重度休克组较中度休克组Cr升高显著，组间比较也有显著性差异(P<0.05)。(2)BUN：COB2B气腹前和撤去气腹后：BUN随失血量的增加而增加。气腹后：中度休克、5 mmHg气腹压时BUN无明显变化，而10 mmHg气腹2 h时方明显升高，当压力升至15 mmHg，气腹0.5 h即显著升高(P<0.05)；重度休克气腹后各时相点的BUN明显增高，且与中度休克组相比也有显著性差异(P<0.05)。(3)RBF：COB2B气腹前和撤去气腹后：RBF随失血量的增加而下降。气腹后：5 mmHg、10 mmHg气腹时，中度休克组RBF 2 h时才明显下降(P<0.05)；15 mmHg气腹时0.5 h即显著减少(P<0.05)；重度休克组气腹0.5 h RBF即明显减少，与中度休克组比较有显著性差异(P<0.05)。
3.心功能(1)LDH：气腹前和撤去气腹后，LDH随着失血量增加呈上升趋势；气腹后：中度休克组LDH无明显改变，重度休克组，在5 mmHg和10 mmHg气腹压时无显著变化，气腹压升至15 mmHg、气腹2 h时LDH才明显升高(P<0.05)。(2)CK-MB：气腹前和撤去气腹后，CK-MB随失血量的增加而增加；CK-MB中度休克组无明显升高，重度休克组在压力为5 mmHg及10 mmHg，气腹2 h时方发生显著改变，而较高的15 mmHg气腹压，气腹0.5 h CK-MB即明显升高，且相同的气腹压组间比较有显著性差异(P<0.05)。(3)cTnT：气腹前和撤去气腹后，重度休克组较中度休克组的cTnT上升显著(P<0.05)；cTnT中度休克组5 mmHg、10 mmHg气腹时无显著上升，但15mmHg气腹压、气腹2 h时增加明显，重度休克组气腹2 h时cTnT亦显著升高，中度和重度休克相同气腹压组间比较有显著性差异(P<0.05)。(4)MBF：COB2B气腹前和撤去气腹后：MBF随失血量的上升而降低。气腹后：中度休克组在5 mmHg时和10 mmHg气腹压时MBF无明显变化，当压力升至15 mmHg、气腹2 h时则显著下降(P<0.05)；重度休克组在5 mmHg气腹压气腹2 h时MBF才明显减少，而10 mmHg、15 mmHg气腹压时，气腹0.5 h时即明显下降(P<0.05)；不同失血量组间比较均有显著性差异，且重度休克时组间比较也有显著性差异(P<0.05)。
结论
1．结合本单位前期研究结果，复苏后建立气腹较未复苏可显著降低失血性休克实验动物的死亡率。
2．中度及重度失血性休克复苏后建立COB2B气腹可导致肝、肾和心功能损害及器官血流量减少。休克程度越重、气腹时间越长、气腹压力越高，脏器功能障碍越明显；相反，休克程度较轻、短时间的低气腹压对机体脏器功能影响较小。
3．中度及重度失血性休克复苏后建立COB2B气腹，肝、肾和心功能障碍程度与失血量、复苏、COB2B气腹、气腹压力和气腹时间关系密切。
Objective
Laparoscopic surgery is rapidly replacing the open approach in many areas of surgeryand has been gaining in popularity in recent years. In previous experiment,we found under10mmHg and 15 mmHg intraabdominal pressure (IAP), experimental animals(withoutresuscitation) with intermediate and severe hemorrhagic shockh had a high mortality. Wealso found that there may be helpful with low COB2B pneumoperitoneum pressure whenlaparoscope used in patients with trauma and hemorrhagic shock condition，and thereshould be careful under no resuscitation when using laparoscope. However, during theprocedure of laparoscopic surgery，the impacts of COB2B pneumoperitoneum on splanchnicfunction to hemorrhagic shock resuscitation are not well clear. In this study we aimed toinvestigate the alterations in hepatic function,renal function and cardiac function bydifferent IAP during COB2B pneumoperitoneum to hemorrhagic shock resuscitation in rabbits。
Methods
Fifty New Zealand rabbits were randomized into 6 groups(intermediate hemorrhagicshock/5 mmHg,intermediate hemorrhagic shock /10 mmHg,intermediate hemorrhagicshock /15 mmHg，severe hemorrhagic shock /5 mmHg，severe hemorrhagic shock /10mmHg，severe hemorrhagic shock /15 mmHg) according to the volume of blood loss andthe intraabdominal pressure．After model was established successfully,venous bloodsamples were collected for measurement of items below at time of prepneumoperitoneum,0.5 h under pneumoperitoneum, 2 h under pneumoperitoneum and 0.5 hafter desufflation．
1. Hepatic function: aminotransferase(AST),alanine aminotransferase(ALT) andhepatic blood flow(HBF).
2. Renal function:aspartate serum creatinine(Cr), blood urea nitrogen (BUN) and renal blood flow (RBF).
3. Cardiac function: lactic dehydrogenase(LDH), isoenzyme activity of creatinekinase(CK-MB),cardiac troponinT(cTnT),and myocardial blood flow(MBF).
Results
1. Hepatic function: (1)AST: With increase of volume of blood loss, AST had aelevation at time of no insuffflation.AST of intermediate hemorrhagic shock statisticallyincreased even at 0.5 h under 5 mmHg IAP(P <0.05). AST of intermediate hemorrhagic hada change significantly compared with severe hemorrhagic shock after ifsufflation (P <0.05).(2)ALT: Compared with severe hemorrhagic shock,cTnT of intermediate hemorrhagic hada significant increase at the time of no pneumoperitoneum(P <0.05). ALT of intermediatehemorrhagic shock were stable until 2 h under 5 mmHg IAP,but ALT statistically increasedeven at 0.5 h under 5 mmHg IAP(P <0.05). Statistical change in ALT of severehemorrhagic shock were observed even at 0.5 h after pneumoperitoneum (P <0.05). ALT ofintermediate hemorrhagic shock had a significant increase compared with severehemorrhagic shock after ifsufflation (P <0.05). (3) HBF: With increase of volume of bloodloss, HBF got down significantly at time of no insuffflation(P <0.05). Compare withpre-insuffflation,HBF of intermediate hemorrhagic shock decrease statistically at 2 h under5 mmHg and10 mmHg IAP,but it increased remarkably even at 0.5 h with 15 mmHg (P<0.05). HBF of severe hemorrhagic shock had a statistical increase even at 0.5 h afterpneumoperitoneum(P <0.05). Compared with intermediate hemorrhagic shock, HBFofsevere hemorrhagic increased significantly after insufflation (P <0.05).
2. Renal function: (1)Cr: Compared with severe hemorrhagic shock, Cr of intermediatehemorrhagic had a significant change at the time of pre-insuffflation and post-suffflation (P<0.05). Cr of intermediate hemorrhagic shock elevated statistically at 2 h under 5 mmHgIAP,however,when IAP increase to 10 mmHg, Cr remarkably increased even at 0.5 h (P<0.05). Significant elevation in Cr of severe hemorrhagic shock were seen even at 0.5 hafter insuffflation (P <0.05).(2)BUN: BUN had a statistical increase at time ofpre-insuffflation and post-suffflation with increase of volume of blood loss (P <0.05). BUNof intermediate hemorrhagic shock did not change significantly under 5 mmHgIAP(P>0.05),but statistically increased at 2 h with 10 mmHg IAP(P <0.05).Under 15mmHg IAP,BUN had a remarkabl increase even 0.5 h(P <0.05). Compared with intermediate hemorrhagic shock, BUN of severe hemorrhagic increased significantly afterinsufflation (P <0.05). (3) RBF: RBF had a no statistical decreasing trendline at time ofpre-insuffflation and post-insuffflation(p>0.05). RBF of intermediate hemorrhagic shockwere stable until 2 h with 5 mmHg and10 mmHg IAP(P <0.05). Under 15 mmHg IAP, RBFhad a remarkabl decrease even 0.5 h(P <0.05). Statistical change in RBF of severehemorrhagic shock were observed even at 0.5 h after pneumoperitoneum (P <0.05).
3. Cardiac function: (1)LDH:LDH had a no-statistical increase at time ofpre-insuffflation and post-suffflation with increase of volume of blood loss.Compare withpre-pneumoperitoneum,under the IAP of 5 mmHg for 2 h,the change of LDH ofintermediate hemorrhagic shock was no statistical significance (p>0.05). LDH of severehemorrhagic shock elevated statistically at 2 h with 15 mmHg IAP(p>0.05).(2)CK-MB:Compare with pre-insuffflation, CK-MB were stable until 2 h under 5 mmHgand 10 mmHg IAP, however, under 15 mmHg,significant increase in CK-MB of severehemorrhagic shock were seen even at 0.5 h after insuffflation (P <0.05). (3)cTnT:At thetime of no pneumoperitoneum, cTnT of intermediate hemorrhagic had a changesignificantly compared with severe hemorrhagic shock(P <0.05). cTnT of intermediatehemorrhagic shock elevated statistically at 2 h under 15 mmHg IAP(P <0.05).Under 5mmHg, 10 mmHg and 15 mmHg IAP, cTnT of severe hemorrhagic shock increasedremarkably at 2 h (P<0.05).(4)MBF: MBF had a no statistical decrease at time ofpre-insuffflation and post -suffflation with increase of volume of blood loss(p>0.05). MBFof intermediate hemorrhagic shock did not change were seen with 5 mmHg and 10 mmHgIAP compare with pre-insufflation, but under15 mmHg IAP, MBF had a significantdecrease at time 2 h(P <0.05). Although statistical decrease in MBF of severe hemorrhagicshock were calculated until 2 h under 5 mmHg, MBF had a remarkabl decline even 0.5 hunder 10 mmHg,15 mmHg IAP(P <0.05).
Conclusions
1. Compare with the results of previous study,we found the resuscitation tohemorrhagic shock in rabbits may decrease remarkably the mortality of the animal.
2. The disturbance of the cardiac, hepatic, renal physiological function caused byreduction of MBF,HBF and RBF to hemorrhagic shock resuscitation in rabbits may berelated to volume of blood loss,COB2Bpneumoperitoneum,the intra-abdominal pressure and the pneumoperitoneum duration.
3. When the Laparoscopic surgery is to be performed for the patients withhemorrhagic shock resuscitation, it should be sure to improve effective blood volumepromptly,choose lower pressure of pneumoperitoneum and shorten the pneumoperitoneumduration.
近年来，腔镜技术由于其各种优点在外科领域应用日益广泛。而失血性休克复苏后行腹腔镜手术时COB2B气腹对机体影响的基础性研究还很少。我们前期的研究提示：中度及重度创伤失血性休克未复苏情况下建立COB2B气腹，当气腹压力为10 mmHg和15mmHg时实验动物死亡率高，且较高腹内压、长时间气腹对实验动物心、肺、脑血流量及生理功能影响较大。本课题通过建立失血性休克复苏兔模型，旨在探讨在循环血流量减少复苏情况下COB2B气腹对肝、肾和心肌血流量及功能的影响，以期为腔镜技术在创伤失血性休克患者的应用进一步提供理论依据。
方法
根据休克程度[中度休克(失血量20％～40％)和重度休克(失血量>40％) ]和气腹压力(5 mmHg，10 mmHg和15 mmHg)将实验动物随机分为6组(中度休克/5 mmHg，中度休克/10 mmHg，中度休克/15 mmHg，重度休克/5 mmHg，重度休克/10 mmHg，重度休克/15 mmHg)，若有死亡则补充，保证每组有效数量8只。制作失血性休克复苏兔模型，分别于气腹前、气腹0.5 h、气腹2 h以及撤去气腹后0.5 h四个时相点检测以下指标：
1.谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、肌酐(serum creatinine,Cr)和尿素氮(Blood urea nitrogen,BUN)用全自动生化仪进行指标检测；乳酸脱氢酶(lactic dehydrogenase,LDH)、肌酸激酶同工酶MB(isoenzyme activity of creatine kinase,CK-MB)和肌钙蛋白(cardiac troponin T,cTnT)则用试剂盒进行检测。
2.肝血流量(hepatic blood flow, HBF)、肾血流量(the blood flow of renal, RBF)和心肌血流量(myocardial blood flow，MBF)用彩色微球法检测。
结果
1.肝功能(1)AST：COB2B气腹前和撤去气腹后：AST与失血量呈正比。气腹后：气腹0.5 h时AST即明显升高(P<0.05),重度休克组同中度休克组相比有显著性差异(P<0.05)。(2)ALT：COB2B气腹前和撤去气腹后：重度休克组较中度休克组的ALT上升显著(P<0.05)。气腹后：中度休克、5 mmHg气腹压时，气腹2 h时ALT才显著增加，气腹压增加至10 mmHg，气腹0.5 h时即明显上升(P<0.05)；重度休克组较中度休克组ALT升高显著，组间比较也有显著性差异(P<0.05)。(3)HBF：COB2B气腹前和撤去气腹后：HBF随失血量的增加而减少。气腹后：5 mmHg和10 mmHg气腹时，中度休克组HBF 2h时才明显下降(P<0.05)；而15 mmHg气腹时，0.5 h即显著减少(P<0.05)；重度休克组气腹0.5 h HBF即明显减少，与中度休克组比较下降明显，且组内比较也有显著性差异(P<0.05)。
2.肾功能(1)Cr：COB2B气腹前和撤去气腹后：重度休克组较中度休克组的Cr上升。气腹后：中度休克、5 mmHg气腹压时，气腹2 h时Cr才显著增加，气腹压增加至10mmHg，气腹0.5 h时即明显上升(P<0.05)；重度休克组较中度休克组Cr升高显著，组间比较也有显著性差异(P<0.05)。(2)BUN：COB2B气腹前和撤去气腹后：BUN随失血量的增加而增加。气腹后：中度休克、5 mmHg气腹压时BUN无明显变化，而10 mmHg气腹2 h时方明显升高，当压力升至15 mmHg，气腹0.5 h即显著升高(P<0.05)；重度休克气腹后各时相点的BUN明显增高，且与中度休克组相比也有显著性差异(P<0.05)。(3)RBF：COB2B气腹前和撤去气腹后：RBF随失血量的增加而下降。气腹后：5 mmHg、10 mmHg气腹时，中度休克组RBF 2 h时才明显下降(P<0.05)；15 mmHg气腹时0.5 h即显著减少(P<0.05)；重度休克组气腹0.5 h RBF即明显减少，与中度休克组比较有显著性差异(P<0.05)。
3.心功能(1)LDH：气腹前和撤去气腹后，LDH随着失血量增加呈上升趋势；气腹后：中度休克组LDH无明显改变，重度休克组，在5 mmHg和10 mmHg气腹压时无显著变化，气腹压升至15 mmHg、气腹2 h时LDH才明显升高(P<0.05)。(2)CK-MB：气腹前和撤去气腹后，CK-MB随失血量的增加而增加；CK-MB中度休克组无明显升高，重度休克组在压力为5 mmHg及10 mmHg，气腹2 h时方发生显著改变，而较高的15 mmHg气腹压，气腹0.5 h CK-MB即明显升高，且相同的气腹压组间比较有显著性差异(P<0.05)。(3)cTnT：气腹前和撤去气腹后，重度休克组较中度休克组的cTnT上升显著(P<0.05)；cTnT中度休克组5 mmHg、10 mmHg气腹时无显著上升，但15mmHg气腹压、气腹2 h时增加明显，重度休克组气腹2 h时cTnT亦显著升高，中度和重度休克相同气腹压组间比较有显著性差异(P<0.05)。(4)MBF：COB2B气腹前和撤去气腹后：MBF随失血量的上升而降低。气腹后：中度休克组在5 mmHg时和10 mmHg气腹压时MBF无明显变化，当压力升至15 mmHg、气腹2 h时则显著下降(P<0.05)；重度休克组在5 mmHg气腹压气腹2 h时MBF才明显减少，而10 mmHg、15 mmHg气腹压时，气腹0.5 h时即明显下降(P<0.05)；不同失血量组间比较均有显著性差异，且重度休克时组间比较也有显著性差异(P<0.05)。
结论
1．结合本单位前期研究结果，复苏后建立气腹较未复苏可显著降低失血性休克实验动物的死亡率。
2．中度及重度失血性休克复苏后建立COB2B气腹可导致肝、肾和心功能损害及器官血流量减少。休克程度越重、气腹时间越长、气腹压力越高，脏器功能障碍越明显；相反，休克程度较轻、短时间的低气腹压对机体脏器功能影响较小。
3．中度及重度失血性休克复苏后建立COB2B气腹，肝、肾和心功能障碍程度与失血量、复苏、COB2B气腹、气腹压力和气腹时间关系密切。
Objective
Laparoscopic surgery is rapidly replacing the open approach in many areas of surgeryand has been gaining in popularity in recent years. In previous experiment,we found under10mmHg and 15 mmHg intraabdominal pressure (IAP), experimental animals(withoutresuscitation) with intermediate and severe hemorrhagic shockh had a high mortality. Wealso found that there may be helpful with low COB2B pneumoperitoneum pressure whenlaparoscope used in patients with trauma and hemorrhagic shock condition，and thereshould be careful under no resuscitation when using laparoscope. However, during theprocedure of laparoscopic surgery，the impacts of COB2B pneumoperitoneum on splanchnicfunction to hemorrhagic shock resuscitation are not well clear. In this study we aimed toinvestigate the alterations in hepatic function,renal function and cardiac function bydifferent IAP during COB2B pneumoperitoneum to hemorrhagic shock resuscitation in rabbits。
Methods
Fifty New Zealand rabbits were randomized into 6 groups(intermediate hemorrhagicshock/5 mmHg,intermediate hemorrhagic shock /10 mmHg,intermediate hemorrhagicshock /15 mmHg，severe hemorrhagic shock /5 mmHg，severe hemorrhagic shock /10mmHg，severe hemorrhagic shock /15 mmHg) according to the volume of blood loss andthe intraabdominal pressure．After model was established successfully,venous bloodsamples were collected for measurement of items below at time of prepneumoperitoneum,0.5 h under pneumoperitoneum, 2 h under pneumoperitoneum and 0.5 hafter desufflation．
1. Hepatic function: aminotransferase(AST),alanine aminotransferase(ALT) andhepatic blood flow(HBF).
2. Renal function:aspartate serum creatinine(Cr), blood urea nitrogen (BUN) and renal blood flow (RBF).
3. Cardiac function: lactic dehydrogenase(LDH), isoenzyme activity of creatinekinase(CK-MB),cardiac troponinT(cTnT),and myocardial blood flow(MBF).
Results
1. Hepatic function: (1)AST: With increase of volume of blood loss, AST had aelevation at time of no insuffflation.AST of intermediate hemorrhagic shock statisticallyincreased even at 0.5 h under 5 mmHg IAP(P <0.05). AST of intermediate hemorrhagic hada change significantly compared with severe hemorrhagic shock after ifsufflation (P <0.05).(2)ALT: Compared with severe hemorrhagic shock,cTnT of intermediate hemorrhagic hada significant increase at the time of no pneumoperitoneum(P <0.05). ALT of intermediatehemorrhagic shock were stable until 2 h under 5 mmHg IAP,but ALT statistically increasedeven at 0.5 h under 5 mmHg IAP(P <0.05). Statistical change in ALT of severehemorrhagic shock were observed even at 0.5 h after pneumoperitoneum (P <0.05). ALT ofintermediate hemorrhagic shock had a significant increase compared with severehemorrhagic shock after ifsufflation (P <0.05). (3) HBF: With increase of volume of bloodloss, HBF got down significantly at time of no insuffflation(P <0.05). Compare withpre-insuffflation,HBF of intermediate hemorrhagic shock decrease statistically at 2 h under5 mmHg and10 mmHg IAP,but it increased remarkably even at 0.5 h with 15 mmHg (P<0.05). HBF of severe hemorrhagic shock had a statistical increase even at 0.5 h afterpneumoperitoneum(P <0.05). Compared with intermediate hemorrhagic shock, HBFofsevere hemorrhagic increased significantly after insufflation (P <0.05).
2. Renal function: (1)Cr: Compared with severe hemorrhagic shock, Cr of intermediatehemorrhagic had a significant change at the time of pre-insuffflation and post-suffflation (P<0.05). Cr of intermediate hemorrhagic shock elevated statistically at 2 h under 5 mmHgIAP,however,when IAP increase to 10 mmHg, Cr remarkably increased even at 0.5 h (P<0.05). Significant elevation in Cr of severe hemorrhagic shock were seen even at 0.5 hafter insuffflation (P <0.05).(2)BUN: BUN had a statistical increase at time ofpre-insuffflation and post-suffflation with increase of volume of blood loss (P <0.05). BUNof intermediate hemorrhagic shock did not change significantly under 5 mmHgIAP(P>0.05),but statistically increased at 2 h with 10 mmHg IAP(P <0.05).Under 15mmHg IAP,BUN had a remarkabl increase even 0.5 h(P <0.05). Compared with intermediate hemorrhagic shock, BUN of severe hemorrhagic increased significantly afterinsufflation (P <0.05). (3) RBF: RBF had a no statistical decreasing trendline at time ofpre-insuffflation and post-insuffflation(p>0.05). RBF of intermediate hemorrhagic shockwere stable until 2 h with 5 mmHg and10 mmHg IAP(P <0.05). Under 15 mmHg IAP, RBFhad a remarkabl decrease even 0.5 h(P <0.05). Statistical change in RBF of severehemorrhagic shock were observed even at 0.5 h after pneumoperitoneum (P <0.05).
3. Cardiac function: (1)LDH:LDH had a no-statistical increase at time ofpre-insuffflation and post-suffflation with increase of volume of blood loss.Compare withpre-pneumoperitoneum,under the IAP of 5 mmHg for 2 h,the change of LDH ofintermediate hemorrhagic shock was no statistical significance (p>0.05). LDH of severehemorrhagic shock elevated statistically at 2 h with 15 mmHg IAP(p>0.05).(2)CK-MB:Compare with pre-insuffflation, CK-MB were stable until 2 h under 5 mmHgand 10 mmHg IAP, however, under 15 mmHg,significant increase in CK-MB of severehemorrhagic shock were seen even at 0.5 h after insuffflation (P <0.05). (3)cTnT:At thetime of no pneumoperitoneum, cTnT of intermediate hemorrhagic had a changesignificantly compared with severe hemorrhagic shock(P <0.05). cTnT of intermediatehemorrhagic shock elevated statistically at 2 h under 15 mmHg IAP(P <0.05).Under 5mmHg, 10 mmHg and 15 mmHg IAP, cTnT of severe hemorrhagic shock increasedremarkably at 2 h (P<0.05).(4)MBF: MBF had a no statistical decrease at time ofpre-insuffflation and post -suffflation with increase of volume of blood loss(p>0.05). MBFof intermediate hemorrhagic shock did not change were seen with 5 mmHg and 10 mmHgIAP compare with pre-insufflation, but under15 mmHg IAP, MBF had a significantdecrease at time 2 h(P <0.05). Although statistical decrease in MBF of severe hemorrhagicshock were calculated until 2 h under 5 mmHg, MBF had a remarkabl decline even 0.5 hunder 10 mmHg,15 mmHg IAP(P <0.05).
Conclusions
1. Compare with the results of previous study,we found the resuscitation tohemorrhagic shock in rabbits may decrease remarkably the mortality of the animal.
2. The disturbance of the cardiac, hepatic, renal physiological function caused byreduction of MBF,HBF and RBF to hemorrhagic shock resuscitation in rabbits may berelated to volume of blood loss,COB2Bpneumoperitoneum,the intra-abdominal pressure and the pneumoperitoneum duration.
3. When the Laparoscopic surgery is to be performed for the patients withhemorrhagic shock resuscitation, it should be sure to improve effective blood volumepromptly,choose lower pressure of pneumoperitoneum and shorten the pneumoperitoneumduration.
引文
1. Demyttenaere S, Feldman L S, Fried G M. Effect of pneumoperitoneum on renal perfusion and function: a systematic review. Surg Endosc, 2007. 21(2): 152-160.
2. Dunn, M.D, McDougall E M. Renal physiology. Laparoscopic considerations. Urol Clin North Am, 2000. 27(4): 609-614.
3. Koivusalo A M, Pere P,Valjus M, et al. Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc, 2008. 22(1): 61-67.
4. Shim C S, Cho J Y, Jung I. S, et al. Through-the-scope double colonic stenting in the management of inoperable proximal malignant colonic obstruction: a pilot study. Endoscopy, 2004. 36(5): 426-431.
5. Marohn M R, Hanly E J. Twenty-first century surgery using twenty-first century technology: surgical robotics. Curr Surg, 2004. 61(5): 466-473.
6. Weinberg J A, Magnotti L J, Edwards N M, et al. "Awake" laparoscopy for the evaluation of equivocal penetrating abdominal wounds. Injury, 2007. 38(1): 60-64.
7. Mallat A F, Mancini M L, Daley B J, et al. The role of laparoscopy in trauma: a ten-year review of diagnosis and therapeutics. Am Surg, 2008. 74(12): 1166-1170.
8. Balen E, Herrera J, Miranda C, et al. The role of laparoscopy in emergency abdominal surgery. An Sist Sanit Navar, 2005. 28(l 3): 81-92.
9.李勇,张连阳,赵松.第三军医大学大坪医院野战外科研究所全军战创伤中心,肝肺撞击伤伴失血后COB2B气腹对兔心肌酶及标志物影响的实验研究.重庆医学, 2007(22): 2249-2251 .
10.李勇,张连阳,赵松.肝肺撞击伤伴失血后COB2B气腹对兔动脉血气影响的实验研究.中华普通外科杂志, 2007(12): 943-946 .
11.赵松,张连阳,李勇,等.肝撞击伤后腹腔镜二氧化碳气腹对胃血流量影响的实验研究.创伤外科杂志, 2007(03): 199-202.
12.赵松,麻晓林,李勇,等.肝撞击伤后气腹对肾血流量影响的实验研究.创伤外科杂志, 2007(05): 401-404.
13.李勇,张连阳,赵松.肝肺撞击伤伴失血后COB2B气腹对兔肺血流量的影响.中华实验外科杂志, 2008. 25(7). 41-44.
14. Zhang L Y, Zhao S, Li Y, et al. Effects of COB2 Bpneumoperitoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock and liver impact injuries. Chin J Traumatol, 2009. 12(1): 45-48.
15. Bulut F, Dervisoglu A, Kesim M, et al. Is pneumoperitoneum harmful during intra-abdominal hemorrhage in rats? J Laparoendosc Adv Surg Tech A, 2005. 15(2): 112-120.
16.吴在德等,主编.外科学.第7版.北京:人民卫生出版社, 2008: 37.
17. Alam H B, Stanton K., Koustova E, et al. Effect of different resuscitation strategies on neutrophil activation in a swine model of hemorrhagic shock. Resuscitation, 2004. 60(1): 91-99.
18. Hoffmann J N, Steinhagen S, Kast C, et al. Chronic left heart catheterization for microvascular blood flow determination in the rabbit: a minimally invasive technique using specially designed port devices. J Surg Res, 2002. 102(2): 119-125.
19. Hasan B A M., Koustova E, Rhee P. Combat casualty care research: From bench to the battlefield. . World J Surg,, 2005. 29(1): 7-11.
20. Shorr R M., Gottlieb M M., Webb K., et al. Selective management of abdominal stab wounds. Importance of the physical examination. Arch Surg, 1988. 123(9): 1141-1145.
21. Thavendran A, Vijayaragavan A, Rasaretnam R. Selective surgery for abdominal stab wounds. Br J Surg, 1975. 62(9): 750-752.
22. Tsikitis V, Biffl W L, Majercik S, et al. Selective clinical management of anterior abdominal stab wounds. Am J Surg, 2004. 188(6): 807-812.
23. Vinces F Y, Madlinger R V. Laparoscopic exploration and lavage in penetrating abdominal stab wounds: a preliminary report. Ulus Travma Acil Cerrahi Derg, 2009. 15(2): 109-112.
24. Chol Y B, Lim K S. Therapeutic laparoscopy for abdominal trauma. Surg Endosc, 2003. 17(3): 421-427.
25. Mathonnet M, Peyrou P, Gainant A, et al. Role of laparoscopy in blunt perforations ofthe small bowel. Surg Endosc, 2003. 17(4): 641-645.
26. Junghans T, Neudecker J, Dorner F, et al. Effect of increasing cardiac preload, sympathetic antagonism, or vasodilation on visceral blood flow during pneumoperitoneum. Langenbecks Arch Surg, 2005. 390(6): 538-543.
27.魏泓.主编.医学实验动物学.成都:四川科学技术出版社, 2001:564-566.
28. Hanly E J, Aurora A R, Fuentes J M, et al. Abdominal insufflation with COB2B causes peritoneal acidosis independent of systemic pH. J Gastrointest Surg, 2005. 9(9): 1245-1251.
29. Cisek L J, Gobet R. M, Peters C A. Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function. J Endourol, 1998. 12(2): 95-100.
30. Blobner M, Bogdanski R, Kochs E, et al. Effects of intraabdominally insufflated carbon dioxide and elevated intraabdominal pressure on splanchnic circulation: an experimental study in pigs. Anesthesiology, 1998. 89(2): 475-482.
31. Guven H E, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. Journal of Gastrointestinal and Liver Diseases, 2007. 16(4): 391-394.
32. Mujicic E, Duric A, Radovanovioc J. Influence of COB2B pneumoperitoneum on liver function. Med Arh, 2006. 60(2): 87-89.
33. Hasukic S. Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc, 2005. 19(11): 1451-1455.
34. Szold A, Weinbroum A A. Carbon dioxide pneumoperitoneum-related liver injury is pressure dependent: A study in an isolated-perfused organ model. Surg Endosc, 2008. 22(2): 365-371.
35. Alexakis N, Gakiopoulou H, Dimitriou C, et al. Liver histology alterations during carbon dioxide pneumoperitoneum in a porcine model. Surg Endosc, 2008. 22(2): 415-420.
36.高峰,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝脏血流的影响.腹腔镜外科杂志, 2005. 10(2): 65-69.
37. Yavuz Y, Ronning K, Bakkelund K, et al. Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig. Surg Endosc, 2006. 20(9): 1394-1401.
38. Orvieto M A, Zorn Kevin C, Mendiola F, et al. Recovery of renal function after complete renal hilar versus artery alone clamping during open and laparoscopic surgery. J Urol, 2007. 177(6): 2371-2374.
39. Clary E M, Bruch S M, Lau C L, et al., Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs. J Surg Res, 2002. 108(1): 32-38.
40. Waseda M, Murakami M, Kato T,et al. Helium gas pneumoperitoneum can improve the recovery of gastrointestinal motility after a laparoscopic operation. Minim Invasive Ther Allied Technol, 2005. 14(1): 14-18.
41. Amir S,Weinbroum A. Carbon dioxide pneumopefitoneum-related liver injury is pressure dependent:A study in an isolated-perfused organ model.Surg Endosc, 2007. 12(3): 675-679.
42. Christoforidis D, Antonescu C, Horisberger J, et al. Endovascular isolated hepatic perfusion under pneumoperitoneum. Eur J Surg Oncol, 2006. 32(1): 113-120.
43. Yokoyama Y, Alterman D M, Sarmadi A H,et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat. J Surg Res, 2002. 105(2): 86-94.
44. Yilmaz S, Koken T, Tokyol C, et al. Can preconditioning reduce laparoscopy-induced tissue injury? Surg Endosc, 2003. 17(5): 819-824.
45. Linares Quevedo A I, Burgos Revilla F J, Villafruela Sanz J J, et al. Usefulness of cytokines as surgical aggression markers in the ischemia-reperfusion syndrome and post transplant renal function in an experimental model of laparoscopic vs. open renal autotransplantation. Arch Esp Urol, 2008. 61(1): 41-54.
46. Dolgor B, Kitano S, Yoshida T, et al. Vasopressin antagonist improves renal function in a rat model of pneumoperitoneum. J Surg Res, 1998. 79(2): 109-114.
47. Windberger U B, Auer R, Keplinger F, et al. The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxidepneumoperitoneum. Gastrointest Endosc, 1999. 49(1): 84-91.
48. Bishara B, Karram T, Khatib S, et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc, 2009. 23(3): 568-576.
49. Ogihara Y, Isshiki A, Kindscher J D, et al.Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors. J Clin Anesth, 1999. 11(5): 406-412.
50. Demyttenaere S V, Feldman L S, Bergman S, et al. Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion? Surg Endosc, 2006. 20(2): 274-280.
51. Cuccurullo L, Ferraraccio F, Scuotto A, et al. The significance of microcirculatory modifications in traumatic lesions of the spinal cord. A preliminary, morphological study on experimentally induced spinal cord traumas. Journal of neurosurgical sciences, 1984. 28(3-4): 139-144.
52. Lindstrom P, Wadstrom J, Ollerstam A, et al. Effects of increased intra-abdominal pressure and volume expansion on renal function in the rat. Nephrol Dial Transplant, 2003. 18(11): 2269-2277.
53. Gutt C N, Oniu T, Mehrabi A, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg, 2004. 21(2): 95-105.
54. Perez J, Taura P, Rueda J, et al. Role of dopamine in renal dysfunction during laparoscopic surgery. Surg Endosc, 2002. 16(9): 1297-1301.
55. Demyttenaere SV, Taqi A, Polyhronopoulos G N, et al. Targeting individual hemodynamics to maintain renal perfusion during pneumoperitoneum in a porcine model. Surgery, 2007. 142(3): 350-356.
56. Olofsson P H, Berg S, Ahn H C, et al. Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure. Crit Care Med, 2009. 37(1): 230-239.
57.王庆文,肖路延,赵欣,等.应用含钾温血持续灌注心肌保护术中心肌酶谱的变化.中华麻醉学杂志, 1997. 17(7): 453-455.
58. Weber M, Rau M, Madlener K, et al. Diagnostic utility of new immunoassays for the cardiac markers cTnI, myoglobin and CK-MB mass. Clin Biochem, 2005. 38(11): 1027-1030.
59. Franco L G, Fioravanti M C, Damasceno A D, et al. Assessment of serum enzymatic markers of cardiomyocytes injury in female dogs submitted to ketamine S(+), atropin and xylazine association. Acta Cir Bras, 2009. 24(1): 36-42.
60. Zarich S W, Qamar A U, Werdmann M J, et al. Value of a single troponin T at the time of presentation as compared to serial CK-MB determinations in patients with suspected myocardial ischemia. Clin Chim Acta, 2002. 326(1-2): 185-192.
61. Kertai M D, Boersma E, Klein J, et al. Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery. Eur J Vasc Endovasc Surg, 2004. 28(1): 59-66.
62. Schafer M, Sgesser H, Reichen J, et al. Alterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc, 2001. 15(10): 1197-1201.
63.王一镗,努力把微创外科推进到一个新的高度.国际呼吸杂志, 2003. 12(12): 797.
64. Simon R J, Rabin J, Kuhls D. Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma, 2002. 53(2): 297-302.
65. Ahmed N, Whelan J, Brownlee J, et al. The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg, 2005. 201(2): 213-216.
66. Chelly M R, Major K, Spivak J, et al. The value of laparoscopy in management of abdominal trauma. Am Surg, 2003. 69(11): 957-960.
67. Steinman M, Da Silva L E, Coelho I J, et al. Hemodynamic and metabolic effects of COB2B pneumoperitoneum in an experimental model of hemorrhagic shock due to retroperitoneal hematoma. Surg Endosc, 1998. 12(5): 416-420.
68. Kheirabadi B S, Tuthill D, Pearson R, al. Metabolic and hemodynamic effects of COB2B pneumoperitoneum in a controlled hemorrhage model. J Trauma, 2001. 50(6): 1031-1043.
69. Sahin D A, Haliloglu B S, Figen K, et al. Stepwise rising COB2B insufflation as anischemic preconditioning method. J Laparoendosc Adv Surg Tech A, 2007. 17(6): 723-729.
70. Cay A, Imamoglu M, Unsal M A, Aydin S, et al. Does Anti-Oxidant Prophylaxis with Melatonin Prevent Adverse Outcomes Related to Increased Oxidative Stress Caused by Laparoscopy in Experimental Rat Model? J Surg Res, 2006. 135(1): 2-8.
71. Ali N A, Eubanks WS, Stamler J S, et al., A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow. Ann Surg, 2005. 241(2): 256-261.
72. Jaskille A, Schechner A, Park K, et al. Abdominal insufflation decreases blood loss and mortality after porcine liver injury. J Trauma, 2005. 59(6): 1305-1308.
73. Velmahos G C, Spaniolas K, Duggan M, et al. Abdominal insufflation for control of bleeding after severe splenic injury. J Trauma, 2007. 63(2): 285-288.
1. Kuebler J F, Kos M, Jesch N K, et al. Carbon dioxide suppresses macrophage superoxide anion production independent of extracellular pH and mitochondrial activity. J Pediatr Surg, 2007. 42(1): 244-248.
2. Guven H E, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. J of Gastrointestinal and Liver Diseases, 2007. 16(4): 391-394.
3. Omari A, Bani-Hani K E. Effect of carbon dioxide pneumoperitoneum on liver function following laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2007. 17(4): 419-424.
4. Mujicic E, Radovanovioc J D A. Influence of COB2B pneumoperitoneum on liver function. Med Arh, 2006. 60(2): 87-89.
5. Xu G S, Liu H N, Li J, et al. Hepatic injury induced by carbon dioxide pneumoperitoneum in experimental rats. World J Gastroenterol, 2009. 15(24): 3060-3064.
6. Bostanci E B, Yol S, Teke Z, et al. Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model. Langenbecks Arch Surg, 2009.16(9):577-586
7. Suh K S, Yi N J, Kim T, et al. Laparoscopy-assisted donor right hepatectomy using a hand port system preserving the middle hepatic vein branches. World J Surg, 2009. 33(3): 526-533.
8.罗顺添,陈伟强,李美荣,等.直肠癌腹腔镜与开腹直肠低位前手术对患者肝功能影响.中国热带医学, 2009. 9(4): 699-700.
9.汪迎,潘凯,王东,等.腹腔镜和开腹结直肠癌手术术后肝功能的比较.中国微创外科杂志, 2005. 5(7): 529-531.
10.卢榜裕,陈钊德.腹腔镜辅助与开腹胃癌根治术的比较.中国微创外科杂志, 2007. 7(9): 831-833.
11.徐大华,孙家邦,李非,等.气腹对肝硬化大鼠肝脏血流的影响.中华外科杂志,2002. 40(9): 696-698.
12. Tsuboi S, Kitano S, Yoshida T, et al. Effects of carbon dioxide pneumoperitoneum on hemodynamics in cirrhotic rats. Surg Endosc, 2002. 16(8): 1220-1225.
13.鲁发龙,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝功能及血清NO影响的实验研究.中国现代医学杂志, 2005. 15(13): 1938-1940.
14.高峰,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝脏血流的影响.腹腔镜外科杂志, 2005. 10(2): 65-69.
15.傅移山,刘海忠,王春,等.不同气腹压对老年患者腹腔镜胆囊切除术后肝功能的影响.中华消化外科杂志, 2006. 5(3): 179 - 181.
16. Sato K., Kawamura T, Wakusawa R. Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg, 2000. 90(5): 1198-1202.
17.赵松,麻晓林,张连阳,等.肝脏撞击伤后气腹压力对肝动脉血流量的影响.中华消化外科杂志, 2007. 6(5):360-362.
18. Yoshida M, Ikeda S, Sumitani D, et al. Alterations in portal vein blood pH, hepatic functions, and hepatic histology in a porcine carbon dioxide pneumoperitoneum model. Surg Endosc, 2010.14(09):831-838.
19. Hasukic S. Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc, 2005. 19(11): 1451-1455.
20. Nickkholgh A, Barro-Bejarano M, Liang R, et al. Signs of reperfusion injury following COB2B pneumoperitoneum: an in vivo microscopy study. Surg Endosc, 2008. 22(1): 122-128.
21. Zhang L Y, Zhao S, Li Y, et al. Effects of COB2B pneumoperitoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock and liver impact injuries. Chin J Traumatol, 2009. 12(1): 45-48.
22. Giraudo G, Brachet Contul R, Caccetta M, et al. Gasless laparoscopy could avoid alterations in hepatic function. Surgical endoscopy, 2001. 15(7): 741-746.
23. Yang Y, J Liu, H Cui, Effect of zinc on cadmium-induced fetal damage. Wei ShengYan Jiu, 1998. 27(2): 112-115.
24. Gutt C N, Schmedt C G, Schmandra T, et al. Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum. Surg Endosc, 2003. 17(12): 1951-1957.
25. Junghans T, Bohm B, Grundel K, et al. Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery, 1997. 121(2): 206-211.
26. Atila K, Terzi C, Ozkardesler S, et al. What is the role of the abdominal perfusion pressure for subclinical hepatic dysfunction in laparoscopic cholecystectomy? J Laparoendosc Adv Surg Tech A, 2009. 19(1): 39-44.
27. Alexakis N. Gakiopoulou H, Dimitriou C,et al. Liver histology alterations during carbon dioxide pneumoperitoneum in a porcine model. Surg Endosc, 2008. 22(2): 415-420.
28. Saenz Medina J, Asuero de Lis MS, Galindo Alvarez J, et al. Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy. Arch Esp Urol, 2007. 60(5): 501-518.
29. Jakimowicz J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc, 1998. 12(2): 129-132.
30. Leister I, Schuler P, Vollmar B, et al. Microcirculation and excretory function of the liver under conditions of carbon dioxide pneumoperitoneum. Surg Endosc, 2004. 18(9): 1358-1363.
31. Ali NA, Eubanks WS, Stamler JS, et al. A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow. Ann Surg, 2005. 241(2): 256-261.
32. Amir Szold, Weinbroum Avi A. Carbon dioxide pneumopefitoneum-related liver injury is pressure dependent:A study in an isolated-perfused organ model.Surg Endosc, 2007. 12(3): 675-679.
33. Meierhenrich R, et al. The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophagealechocardiography. Anesth Analg, 2005. 100(2): 340-347.
34. Klopfenstein C E, Morel D R, Clergue F, et al. Effects of abdominal COB2 Binsufflation and changes of position on hepatic blood flow in anesthetized pigs. Am J Physiol, 1998. 275(2): 900-905.
35.陈琦,陶静茹,尤新民,等.妇科腹腔镜手术气腹、体位及高碳酸血症对循环功能的影响.中国内镜杂志, 2006. 12(4): 347-349.
36. Schafer M, Krahenbuhl L. Effect of laparoscopy on intra-abdominal blood flow. Surgery, 2001. 129(4): 385-389.
37. Schmandra T C, Kim Z G, Gutt C N. Effect of insufflation gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc, 2001. 15(4): 405-408.
38. Bendet N, Morozov V, Lavi R, et al. Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity? Hepatogastroenterology, 1999. 46(27): 1603-1606.
39. Yavuz Y, Ronning K, Bakkelund K, et al. Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig. Surg Endosc, 2006. 20(9): 1394-1401.
40. Schafer M, Sagesser H, Reichen J, et al. Alterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc, 2001. 15(10): 1197-1201.
41.罗琪,吴绍峰. COB2B气腹对腹膜炎大鼠的肠道内毒素细菌移位的影响.四川大学学报(医学版), 2009. 40(1): 141-144.
42. Hanly E J, Fuentes J M, Aurora A R, et al. Carbon dioxide pneumoperitoneum prevents mortality from sepsis. Surg Endosc, 2006. 20(9): 1482-1487.
43. Junghans T, Modersohn D, Dorner F, et al. Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum. Surg Endosc, 2006. 20(5): 763-769.
44. Koivusalo A M, Pere P, Valjus M, et al. Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc, 2008. 22(1): 61-67.
45. Bickel A, Loberant N, Bersudsky M,et al. Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum. Arch Surg, 2007. 142(2): 119-124.
46. Yilmaz S, Koken T, Tokyol C, et al. Can preconditioning reduce laparoscopy-induced tissue injury? Surg Endosc, 2003. 17(5): 819-824.
47. Mallat A F, Mancini M L, Daley B J, et al. The role of laparoscopy in trauma: a ten-year review of diagnosis and therapeutics. Am Surg, 2008. 74(12): 1166-1170.
48. Chol Y B, Lim K S. Therapeutic laparoscopy for abdominal trauma. Surg Endosc, 2003. 17(3): 421-427.
2. Dunn, M.D, McDougall E M. Renal physiology. Laparoscopic considerations. Urol Clin North Am, 2000. 27(4): 609-614.
3. Koivusalo A M, Pere P,Valjus M, et al. Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc, 2008. 22(1): 61-67.
4. Shim C S, Cho J Y, Jung I. S, et al. Through-the-scope double colonic stenting in the management of inoperable proximal malignant colonic obstruction: a pilot study. Endoscopy, 2004. 36(5): 426-431.
5. Marohn M R, Hanly E J. Twenty-first century surgery using twenty-first century technology: surgical robotics. Curr Surg, 2004. 61(5): 466-473.
6. Weinberg J A, Magnotti L J, Edwards N M, et al. "Awake" laparoscopy for the evaluation of equivocal penetrating abdominal wounds. Injury, 2007. 38(1): 60-64.
7. Mallat A F, Mancini M L, Daley B J, et al. The role of laparoscopy in trauma: a ten-year review of diagnosis and therapeutics. Am Surg, 2008. 74(12): 1166-1170.
8. Balen E, Herrera J, Miranda C, et al. The role of laparoscopy in emergency abdominal surgery. An Sist Sanit Navar, 2005. 28(l 3): 81-92.
9.李勇,张连阳,赵松.第三军医大学大坪医院野战外科研究所全军战创伤中心,肝肺撞击伤伴失血后COB2B气腹对兔心肌酶及标志物影响的实验研究.重庆医学, 2007(22): 2249-2251 .
10.李勇,张连阳,赵松.肝肺撞击伤伴失血后COB2B气腹对兔动脉血气影响的实验研究.中华普通外科杂志, 2007(12): 943-946 .
11.赵松,张连阳,李勇,等.肝撞击伤后腹腔镜二氧化碳气腹对胃血流量影响的实验研究.创伤外科杂志, 2007(03): 199-202.
12.赵松,麻晓林,李勇,等.肝撞击伤后气腹对肾血流量影响的实验研究.创伤外科杂志, 2007(05): 401-404.
13.李勇,张连阳,赵松.肝肺撞击伤伴失血后COB2B气腹对兔肺血流量的影响.中华实验外科杂志, 2008. 25(7). 41-44.
14. Zhang L Y, Zhao S, Li Y, et al. Effects of COB2 Bpneumoperitoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock and liver impact injuries. Chin J Traumatol, 2009. 12(1): 45-48.
15. Bulut F, Dervisoglu A, Kesim M, et al. Is pneumoperitoneum harmful during intra-abdominal hemorrhage in rats? J Laparoendosc Adv Surg Tech A, 2005. 15(2): 112-120.
16.吴在德等,主编.外科学.第7版.北京:人民卫生出版社, 2008: 37.
17. Alam H B, Stanton K., Koustova E, et al. Effect of different resuscitation strategies on neutrophil activation in a swine model of hemorrhagic shock. Resuscitation, 2004. 60(1): 91-99.
18. Hoffmann J N, Steinhagen S, Kast C, et al. Chronic left heart catheterization for microvascular blood flow determination in the rabbit: a minimally invasive technique using specially designed port devices. J Surg Res, 2002. 102(2): 119-125.
19. Hasan B A M., Koustova E, Rhee P. Combat casualty care research: From bench to the battlefield. . World J Surg,, 2005. 29(1): 7-11.
20. Shorr R M., Gottlieb M M., Webb K., et al. Selective management of abdominal stab wounds. Importance of the physical examination. Arch Surg, 1988. 123(9): 1141-1145.
21. Thavendran A, Vijayaragavan A, Rasaretnam R. Selective surgery for abdominal stab wounds. Br J Surg, 1975. 62(9): 750-752.
22. Tsikitis V, Biffl W L, Majercik S, et al. Selective clinical management of anterior abdominal stab wounds. Am J Surg, 2004. 188(6): 807-812.
23. Vinces F Y, Madlinger R V. Laparoscopic exploration and lavage in penetrating abdominal stab wounds: a preliminary report. Ulus Travma Acil Cerrahi Derg, 2009. 15(2): 109-112.
24. Chol Y B, Lim K S. Therapeutic laparoscopy for abdominal trauma. Surg Endosc, 2003. 17(3): 421-427.
25. Mathonnet M, Peyrou P, Gainant A, et al. Role of laparoscopy in blunt perforations ofthe small bowel. Surg Endosc, 2003. 17(4): 641-645.
26. Junghans T, Neudecker J, Dorner F, et al. Effect of increasing cardiac preload, sympathetic antagonism, or vasodilation on visceral blood flow during pneumoperitoneum. Langenbecks Arch Surg, 2005. 390(6): 538-543.
27.魏泓.主编.医学实验动物学.成都:四川科学技术出版社, 2001:564-566.
28. Hanly E J, Aurora A R, Fuentes J M, et al. Abdominal insufflation with COB2B causes peritoneal acidosis independent of systemic pH. J Gastrointest Surg, 2005. 9(9): 1245-1251.
29. Cisek L J, Gobet R. M, Peters C A. Pneumoperitoneum produces reversible renal dysfunction in animals with normal and chronically reduced renal function. J Endourol, 1998. 12(2): 95-100.
30. Blobner M, Bogdanski R, Kochs E, et al. Effects of intraabdominally insufflated carbon dioxide and elevated intraabdominal pressure on splanchnic circulation: an experimental study in pigs. Anesthesiology, 1998. 89(2): 475-482.
31. Guven H E, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. Journal of Gastrointestinal and Liver Diseases, 2007. 16(4): 391-394.
32. Mujicic E, Duric A, Radovanovioc J. Influence of COB2B pneumoperitoneum on liver function. Med Arh, 2006. 60(2): 87-89.
33. Hasukic S. Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc, 2005. 19(11): 1451-1455.
34. Szold A, Weinbroum A A. Carbon dioxide pneumoperitoneum-related liver injury is pressure dependent: A study in an isolated-perfused organ model. Surg Endosc, 2008. 22(2): 365-371.
35. Alexakis N, Gakiopoulou H, Dimitriou C, et al. Liver histology alterations during carbon dioxide pneumoperitoneum in a porcine model. Surg Endosc, 2008. 22(2): 415-420.
36.高峰,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝脏血流的影响.腹腔镜外科杂志, 2005. 10(2): 65-69.
37. Yavuz Y, Ronning K, Bakkelund K, et al. Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig. Surg Endosc, 2006. 20(9): 1394-1401.
38. Orvieto M A, Zorn Kevin C, Mendiola F, et al. Recovery of renal function after complete renal hilar versus artery alone clamping during open and laparoscopic surgery. J Urol, 2007. 177(6): 2371-2374.
39. Clary E M, Bruch S M, Lau C L, et al., Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs. J Surg Res, 2002. 108(1): 32-38.
40. Waseda M, Murakami M, Kato T,et al. Helium gas pneumoperitoneum can improve the recovery of gastrointestinal motility after a laparoscopic operation. Minim Invasive Ther Allied Technol, 2005. 14(1): 14-18.
41. Amir S,Weinbroum A. Carbon dioxide pneumopefitoneum-related liver injury is pressure dependent:A study in an isolated-perfused organ model.Surg Endosc, 2007. 12(3): 675-679.
42. Christoforidis D, Antonescu C, Horisberger J, et al. Endovascular isolated hepatic perfusion under pneumoperitoneum. Eur J Surg Oncol, 2006. 32(1): 113-120.
43. Yokoyama Y, Alterman D M, Sarmadi A H,et al. Hepatic vascular response to elevated intraperitoneal pressure in the rat. J Surg Res, 2002. 105(2): 86-94.
44. Yilmaz S, Koken T, Tokyol C, et al. Can preconditioning reduce laparoscopy-induced tissue injury? Surg Endosc, 2003. 17(5): 819-824.
45. Linares Quevedo A I, Burgos Revilla F J, Villafruela Sanz J J, et al. Usefulness of cytokines as surgical aggression markers in the ischemia-reperfusion syndrome and post transplant renal function in an experimental model of laparoscopic vs. open renal autotransplantation. Arch Esp Urol, 2008. 61(1): 41-54.
46. Dolgor B, Kitano S, Yoshida T, et al. Vasopressin antagonist improves renal function in a rat model of pneumoperitoneum. J Surg Res, 1998. 79(2): 109-114.
47. Windberger U B, Auer R, Keplinger F, et al. The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxidepneumoperitoneum. Gastrointest Endosc, 1999. 49(1): 84-91.
48. Bishara B, Karram T, Khatib S, et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc, 2009. 23(3): 568-576.
49. Ogihara Y, Isshiki A, Kindscher J D, et al.Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors. J Clin Anesth, 1999. 11(5): 406-412.
50. Demyttenaere S V, Feldman L S, Bergman S, et al. Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion? Surg Endosc, 2006. 20(2): 274-280.
51. Cuccurullo L, Ferraraccio F, Scuotto A, et al. The significance of microcirculatory modifications in traumatic lesions of the spinal cord. A preliminary, morphological study on experimentally induced spinal cord traumas. Journal of neurosurgical sciences, 1984. 28(3-4): 139-144.
52. Lindstrom P, Wadstrom J, Ollerstam A, et al. Effects of increased intra-abdominal pressure and volume expansion on renal function in the rat. Nephrol Dial Transplant, 2003. 18(11): 2269-2277.
53. Gutt C N, Oniu T, Mehrabi A, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg, 2004. 21(2): 95-105.
54. Perez J, Taura P, Rueda J, et al. Role of dopamine in renal dysfunction during laparoscopic surgery. Surg Endosc, 2002. 16(9): 1297-1301.
55. Demyttenaere SV, Taqi A, Polyhronopoulos G N, et al. Targeting individual hemodynamics to maintain renal perfusion during pneumoperitoneum in a porcine model. Surgery, 2007. 142(3): 350-356.
56. Olofsson P H, Berg S, Ahn H C, et al. Gastrointestinal microcirculation and cardiopulmonary function during experimentally increased intra-abdominal pressure. Crit Care Med, 2009. 37(1): 230-239.
57.王庆文,肖路延,赵欣,等.应用含钾温血持续灌注心肌保护术中心肌酶谱的变化.中华麻醉学杂志, 1997. 17(7): 453-455.
58. Weber M, Rau M, Madlener K, et al. Diagnostic utility of new immunoassays for the cardiac markers cTnI, myoglobin and CK-MB mass. Clin Biochem, 2005. 38(11): 1027-1030.
59. Franco L G, Fioravanti M C, Damasceno A D, et al. Assessment of serum enzymatic markers of cardiomyocytes injury in female dogs submitted to ketamine S(+), atropin and xylazine association. Acta Cir Bras, 2009. 24(1): 36-42.
60. Zarich S W, Qamar A U, Werdmann M J, et al. Value of a single troponin T at the time of presentation as compared to serial CK-MB determinations in patients with suspected myocardial ischemia. Clin Chim Acta, 2002. 326(1-2): 185-192.
61. Kertai M D, Boersma E, Klein J, et al. Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery. Eur J Vasc Endovasc Surg, 2004. 28(1): 59-66.
62. Schafer M, Sgesser H, Reichen J, et al. Alterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc, 2001. 15(10): 1197-1201.
63.王一镗,努力把微创外科推进到一个新的高度.国际呼吸杂志, 2003. 12(12): 797.
64. Simon R J, Rabin J, Kuhls D. Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma, 2002. 53(2): 297-302.
65. Ahmed N, Whelan J, Brownlee J, et al. The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg, 2005. 201(2): 213-216.
66. Chelly M R, Major K, Spivak J, et al. The value of laparoscopy in management of abdominal trauma. Am Surg, 2003. 69(11): 957-960.
67. Steinman M, Da Silva L E, Coelho I J, et al. Hemodynamic and metabolic effects of COB2B pneumoperitoneum in an experimental model of hemorrhagic shock due to retroperitoneal hematoma. Surg Endosc, 1998. 12(5): 416-420.
68. Kheirabadi B S, Tuthill D, Pearson R, al. Metabolic and hemodynamic effects of COB2B pneumoperitoneum in a controlled hemorrhage model. J Trauma, 2001. 50(6): 1031-1043.
69. Sahin D A, Haliloglu B S, Figen K, et al. Stepwise rising COB2B insufflation as anischemic preconditioning method. J Laparoendosc Adv Surg Tech A, 2007. 17(6): 723-729.
70. Cay A, Imamoglu M, Unsal M A, Aydin S, et al. Does Anti-Oxidant Prophylaxis with Melatonin Prevent Adverse Outcomes Related to Increased Oxidative Stress Caused by Laparoscopy in Experimental Rat Model? J Surg Res, 2006. 135(1): 2-8.
71. Ali N A, Eubanks WS, Stamler J S, et al., A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow. Ann Surg, 2005. 241(2): 256-261.
72. Jaskille A, Schechner A, Park K, et al. Abdominal insufflation decreases blood loss and mortality after porcine liver injury. J Trauma, 2005. 59(6): 1305-1308.
73. Velmahos G C, Spaniolas K, Duggan M, et al. Abdominal insufflation for control of bleeding after severe splenic injury. J Trauma, 2007. 63(2): 285-288.
1. Kuebler J F, Kos M, Jesch N K, et al. Carbon dioxide suppresses macrophage superoxide anion production independent of extracellular pH and mitochondrial activity. J Pediatr Surg, 2007. 42(1): 244-248.
2. Guven H E, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. J of Gastrointestinal and Liver Diseases, 2007. 16(4): 391-394.
3. Omari A, Bani-Hani K E. Effect of carbon dioxide pneumoperitoneum on liver function following laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2007. 17(4): 419-424.
4. Mujicic E, Radovanovioc J D A. Influence of COB2B pneumoperitoneum on liver function. Med Arh, 2006. 60(2): 87-89.
5. Xu G S, Liu H N, Li J, et al. Hepatic injury induced by carbon dioxide pneumoperitoneum in experimental rats. World J Gastroenterol, 2009. 15(24): 3060-3064.
6. Bostanci E B, Yol S, Teke Z, et al. Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model. Langenbecks Arch Surg, 2009.16(9):577-586
7. Suh K S, Yi N J, Kim T, et al. Laparoscopy-assisted donor right hepatectomy using a hand port system preserving the middle hepatic vein branches. World J Surg, 2009. 33(3): 526-533.
8.罗顺添,陈伟强,李美荣,等.直肠癌腹腔镜与开腹直肠低位前手术对患者肝功能影响.中国热带医学, 2009. 9(4): 699-700.
9.汪迎,潘凯,王东,等.腹腔镜和开腹结直肠癌手术术后肝功能的比较.中国微创外科杂志, 2005. 5(7): 529-531.
10.卢榜裕,陈钊德.腹腔镜辅助与开腹胃癌根治术的比较.中国微创外科杂志, 2007. 7(9): 831-833.
11.徐大华,孙家邦,李非,等.气腹对肝硬化大鼠肝脏血流的影响.中华外科杂志,2002. 40(9): 696-698.
12. Tsuboi S, Kitano S, Yoshida T, et al. Effects of carbon dioxide pneumoperitoneum on hemodynamics in cirrhotic rats. Surg Endosc, 2002. 16(8): 1220-1225.
13.鲁发龙,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝功能及血清NO影响的实验研究.中国现代医学杂志, 2005. 15(13): 1938-1940.
14.高峰,陶凯雄,王国斌,等. COB2B气腹对肝硬化兔肝脏血流的影响.腹腔镜外科杂志, 2005. 10(2): 65-69.
15.傅移山,刘海忠,王春,等.不同气腹压对老年患者腹腔镜胆囊切除术后肝功能的影响.中华消化外科杂志, 2006. 5(3): 179 - 181.
16. Sato K., Kawamura T, Wakusawa R. Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg, 2000. 90(5): 1198-1202.
17.赵松,麻晓林,张连阳,等.肝脏撞击伤后气腹压力对肝动脉血流量的影响.中华消化外科杂志, 2007. 6(5):360-362.
18. Yoshida M, Ikeda S, Sumitani D, et al. Alterations in portal vein blood pH, hepatic functions, and hepatic histology in a porcine carbon dioxide pneumoperitoneum model. Surg Endosc, 2010.14(09):831-838.
19. Hasukic S. Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopic cholecystectomy. Surg Endosc, 2005. 19(11): 1451-1455.
20. Nickkholgh A, Barro-Bejarano M, Liang R, et al. Signs of reperfusion injury following COB2B pneumoperitoneum: an in vivo microscopy study. Surg Endosc, 2008. 22(1): 122-128.
21. Zhang L Y, Zhao S, Li Y, et al. Effects of COB2B pneumoperitoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock and liver impact injuries. Chin J Traumatol, 2009. 12(1): 45-48.
22. Giraudo G, Brachet Contul R, Caccetta M, et al. Gasless laparoscopy could avoid alterations in hepatic function. Surgical endoscopy, 2001. 15(7): 741-746.
23. Yang Y, J Liu, H Cui, Effect of zinc on cadmium-induced fetal damage. Wei ShengYan Jiu, 1998. 27(2): 112-115.
24. Gutt C N, Schmedt C G, Schmandra T, et al. Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum. Surg Endosc, 2003. 17(12): 1951-1957.
25. Junghans T, Bohm B, Grundel K, et al. Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery, 1997. 121(2): 206-211.
26. Atila K, Terzi C, Ozkardesler S, et al. What is the role of the abdominal perfusion pressure for subclinical hepatic dysfunction in laparoscopic cholecystectomy? J Laparoendosc Adv Surg Tech A, 2009. 19(1): 39-44.
27. Alexakis N. Gakiopoulou H, Dimitriou C,et al. Liver histology alterations during carbon dioxide pneumoperitoneum in a porcine model. Surg Endosc, 2008. 22(2): 415-420.
28. Saenz Medina J, Asuero de Lis MS, Galindo Alvarez J, et al. Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy. Arch Esp Urol, 2007. 60(5): 501-518.
29. Jakimowicz J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc, 1998. 12(2): 129-132.
30. Leister I, Schuler P, Vollmar B, et al. Microcirculation and excretory function of the liver under conditions of carbon dioxide pneumoperitoneum. Surg Endosc, 2004. 18(9): 1358-1363.
31. Ali NA, Eubanks WS, Stamler JS, et al. A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow. Ann Surg, 2005. 241(2): 256-261.
32. Amir Szold, Weinbroum Avi A. Carbon dioxide pneumopefitoneum-related liver injury is pressure dependent:A study in an isolated-perfused organ model.Surg Endosc, 2007. 12(3): 675-679.
33. Meierhenrich R, et al. The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophagealechocardiography. Anesth Analg, 2005. 100(2): 340-347.
34. Klopfenstein C E, Morel D R, Clergue F, et al. Effects of abdominal COB2 Binsufflation and changes of position on hepatic blood flow in anesthetized pigs. Am J Physiol, 1998. 275(2): 900-905.
35.陈琦,陶静茹,尤新民,等.妇科腹腔镜手术气腹、体位及高碳酸血症对循环功能的影响.中国内镜杂志, 2006. 12(4): 347-349.
36. Schafer M, Krahenbuhl L. Effect of laparoscopy on intra-abdominal blood flow. Surgery, 2001. 129(4): 385-389.
37. Schmandra T C, Kim Z G, Gutt C N. Effect of insufflation gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc, 2001. 15(4): 405-408.
38. Bendet N, Morozov V, Lavi R, et al. Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity? Hepatogastroenterology, 1999. 46(27): 1603-1606.
39. Yavuz Y, Ronning K, Bakkelund K, et al. Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig. Surg Endosc, 2006. 20(9): 1394-1401.
40. Schafer M, Sagesser H, Reichen J, et al. Alterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc, 2001. 15(10): 1197-1201.
41.罗琪,吴绍峰. COB2B气腹对腹膜炎大鼠的肠道内毒素细菌移位的影响.四川大学学报(医学版), 2009. 40(1): 141-144.
42. Hanly E J, Fuentes J M, Aurora A R, et al. Carbon dioxide pneumoperitoneum prevents mortality from sepsis. Surg Endosc, 2006. 20(9): 1482-1487.
43. Junghans T, Modersohn D, Dorner F, et al. Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum. Surg Endosc, 2006. 20(5): 763-769.
44. Koivusalo A M, Pere P, Valjus M, et al. Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc, 2008. 22(1): 61-67.
45. Bickel A, Loberant N, Bersudsky M,et al. Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum. Arch Surg, 2007. 142(2): 119-124.
46. Yilmaz S, Koken T, Tokyol C, et al. Can preconditioning reduce laparoscopy-induced tissue injury? Surg Endosc, 2003. 17(5): 819-824.
47. Mallat A F, Mancini M L, Daley B J, et al. The role of laparoscopy in trauma: a ten-year review of diagnosis and therapeutics. Am Surg, 2008. 74(12): 1166-1170.
48. Chol Y B, Lim K S. Therapeutic laparoscopy for abdominal trauma. Surg Endosc, 2003. 17(3): 421-427.