Effects Of CO₂ Pneumoperitoneum On Hepatic, Renal And Cardiac Function To Hemorrhagic Shock Resuscitation In Rabbits

ObjectiveLaparoscopic 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。MethodsFifty 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).Results1. 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).Conclusions1. 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.