新生児外科における腹圧亢進時の嫌気性代謝に関する研究

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  • STUDIES ON THE ANAEROBIC METABOLISM CAUSED BY INCREASE OF ABDOMINAL PRESSURE IN NEONATAL SURGERY
  • シンセイジ ゲカ ニ オケル フクアツ コウシンジ ノ ケンキセイ タイシャ ニ カンスル ケンキュウ

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Thirty juvenile dogs were used for experimental study. Abdominal cavity pressure was experimentally increased with the criterion of peripheral venous pressure. To study the influence of increase in abdominal pressure on respiratory and circulatory disturbances, analysis of aspired gas and blood gas, determinations of the values of lactic acid and pyruvic acid in the peripheral blood and calculation of excess lactate were carried out.<BR>The following results were obtained.<BR>1. When abdominal pressure was increased by 3 times as much as initial value (low pressure group), the metabolic conditions tended to be improved with the lapse of time. On the other hand, when abdominal pressure was increased 5-6 times as much as initial value ( high pressure group), the metabolic conditions were aggravated into irreversible conditions with the lapse of time.<BR>2. Fluctuations in metabolic conditions induced by increasing abdominal pressure were principally characterized with metabolic acidosis due to an increase in lactic acid. In the low pressure group respiration was compensated by hyperventilation and metabolic acidosis occurred slightly, and the same phenomenon was shown during first 60 minutes in the high pressure group.<BR>3. After 90 minutes, the high pressure group showed hyperventilation replaced by hypoventilation with elevation of PaCO2, which indicated the disappearance of compensatory function for respiration and transition of metabolic acidosis to respiratory metabolic acidosis combined with respiratory acidosis.<BR>4. Immediately after an increase of high abdominal compression, a remarkable increase in lactic acid and excess lactate was observed. The finding might be considered the appearance of tissue hypoxia and acceleration of anaerobic metabolism.<BR>5. It was considered that some correlation existed among pH, lactic acid and excess lactate, and also between PaO2 and excess lactate.<BR>The experiment showed that an appropriate operation method for the infantile hernia should be selected according to the degree of abdominal cavity pressure with a criterion of the peripheral venous pressure. It is considered more important, to grasp the changes of metabolic conditions by determining the values of lactic acid and excess lactate, together with the analysis of pH value of blood and the analysis of blood gas through out the post operative course.

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