不同年龄小儿眼科手术静脉全麻中P_(ET)CO_2的变化研究

The changes of waveform and value of P_(ET)CO_2 in children of different age during ophthalmic surgery under intravenous anesthesia

目的研究不同年龄组患儿静脉全麻期间PETCO2分压和波形的变化规律及其临床意义.方法在1～6岁和7～12岁不同眼科手术患儿中各随机选择48例,分别为L组(1～6岁)和H组(7～12岁).在自主呼吸静脉全麻下采用鼻氧管采气方法动态观察静脉全麻前、麻醉后15、30、45、60min呼气末二氧化碳PETCO2分压和波形变化.结果 L组30min、H组45min PETCO2分压明显升高,两组均可出现三类异常的CO2波形,其中L组Ⅱ类波形发生率明显高于H组.结论小儿眼科手术静脉全麻中容易出现呼吸功能减弱,呼吸道不通畅而导致CO2积蓄,低年龄组更为显著;鼻氧管PETCO2监测可提高小儿眼科手术静脉全麻的安全性.

Objective To study the change of waveform and value of P ETCO 2 in children of different age during ophthalmic surgery under total intravenous anesthesia (TIVA) at 15、30、45、60min.Methods 96 children scheduled for ophthalmic surgery were divided into L group (1~6years old) and H group (7~12years old),48 cases in each group.The change of waveform and value of P ETCO 2 under TIVA and spontaneously breathing were studied through nasal cannula in two groups.Results P ETCO 2 showed significant increase after postanestheive 30 min and 45 min in L group and H group respectively. The P ETCO 2 waveform showed three types of abnormality with high occurrence rate in two groups,while the occurrence rate of type Ⅱ abnormal waveform were statistically higher in lower age group than that in higher age group.Conclusion CO 2 accumulation is a common complication due to respiratory depression and respiratory tract obstruction in pediatric surgery under TIVA and more serious in child lower than 6 years old.P ETCO 2 monitoring through nasal cannula can improve the safety of children during ophthalmic surgery under total intravenous anesthesia(TIVA).