二氧化碳气腹对婴幼儿呼吸生理的影响及呼吸管理

The influences of pneumoperitoneum with carbon dioxide on respiratory physiology and the management of mechanical ventilation in infants undergoing laparoscope surgery

目的观察二氧化碳(CO2)气腹对婴幼儿腹腔镜手术中呼吸生理的影响并探讨手术中呼吸管理的要点.方法20例ASA Ⅰ～Ⅱ级行选择性腹腔镜手术婴幼儿,采用骶管阻滞加静吸复合麻醉;麻醉期间采用压力控制机械通气,调节呼气末二氧化碳分压(PETCO2)维持在32～38 mmHg.麻醉维持采用异氟醚吸入,丙泊酚、维库溴铵持续静脉输注.监测ECG、HR、BP、SpO2、PETCO2、中心静脉压(CVP)、胸肺顺应性(Crs)和脑电双频指数(BIS),并定时做血气分析.结果与气腹前相比,气腹后40 min动脉血二氧化碳总量(TCO2)、动脉血二氧化碳分压(PaCO2)显著增加(P＜0.05);气腹后即刻、气腹后40min与插管前、插管后相比,HR显著下降,RR、气道峰压(Pmax)、PETCO2显著上升(P＜0.05).结论腹腔镜手术期间,气腹对婴幼儿呼吸生理具有比较明显的影响.

Objective To investigate The influence of pneumoperitoneum with carbon dioxide on respiratory physiology and the management of mechanical ventilation in infants undergoing laparoscope surgery. Methods Twenty ASAⅠ-Ⅱ patients aged 6-18 months, weighing 8-12kg scheduled for laparoscope surgery were enrolled in this study. The patients recived caudal block and combined with intravenous-inhalation anesthesia. Pressure controlled ventilation(PCV)was performed after tracheal intubation. P_(ET)CO_2 was maintained at 32-38mmHg. Anesthesia was maintained by isoflurane 1%-2% with propofol and vecuronium intravenous infusion.ECG, HR, BP, SpO_2, CVP, P_(ET)CO_(2, )C_(rs )and BIS were monitored continuously. Arterial blood gases were analyzed before pneumoperitoneum and 40min after pneumoperitoneum was performed. Results RR, P_(max), P_(ET)CO_2 and TCO_2, PaCO_2 were increased significantly 40min after pneumoperitoneum compared with that before(P<0.05) HR significantly decreased after pneumoperitoneum (P<0.05).Conclusion Pneumoperitoneum with (carbon) dioxide influence significantly the respiratory physiology in infants during the laparoscope surgery, so respiratory management is very important for these patients.