Kreislaufmechanik bei intra-
und extraperitonealen minimal invasiven Eingriffen unter
CO₂-Insufflation. Auswirkungen
im Niederdrucksystem

Zusammenfassung.

In vielen Studien wurden die hämodynamischen Veränderungen unter intraperitonealer CO₂-Insufflation und der damit verbundenen intraabdominalen Druckerhöhung untersucht. Die Ergebnisse sind jedoch sehr unterschiedlich und scheinen u. a. beeinflusst zu sein von intravasalem Blutvolumen und der Körperposition. Mit der Betrachtung von abdominaler Vena cava inferior und umgebendem Abdomen als Starling'scher Widerstand für den venösen Rückfluss zum Herzen können jedoch die bei unterschiedlicher intraperitonealer Druckerhöhung auftretenden hämodynamischen Veränderungen größtenteils erklärt und scheinbare Widersprüche aufgelöst werden. Danach wird der Blutfluss über die Vena cava inferior als Funktion der Druckdifferenz zwischen stromaufwärts bestehendem intravasalen Venendruck und intrabdominalem Druck bzw. als Druckdifferenz zwischen stromaufwärts herrschendem venösen Druck und intrathorakalem (proximalen) Venendruck betrachtet.

Intraperitoneal and Extraperitoneal CO₂-Insufflation for Minimal Invasive Surgery. Impact on the Venous Low Pressure System.

Several studies have addressed the cardiovascular effects of intraperitoneal carbon dioxide insufflation and increased intraabdominal pressure. The pathophysiology of this intervention is complex. Reported results apparently differ depending on which patients are studied and are affected by blood volume and/or positioning. With the Starling resistor concept of abdominal venous return in which, analogous to pulmonary vascular zones, flow through the inferior vena cava is considered a function of the pressure difference between upstream venous and either abdominal pressure or downstream intrathoracic caval vein pressure, different results reported in literature can be reconciled.

Key words:

minimal invasive Chirurgie - CO₂-Insufflation - Starling'scher Widerstand - Vena cava

Key words:

laparoscopy - retroperitoneoscopy - surgery - CO₂-insufflation - Starling resistor - Vena cava

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