全凭静脉麻醉在新生儿腹腔镜手术中的应用

Total intravenous anesthesia used for laparoscopic surgery in neonates

目的观察人工气腹对新生儿呼吸、循环的影响，以探讨新生儿腹腔镜手术的麻醉方法及呼吸和循环的管理．方法新生儿腹腔镜手术40例，年龄2—30d，体重2—5kg。ASAⅠ～Ⅱ级。采用全凭静脉麻醉，压力控制呼吸的方法．术中连续监测气腹前、气腹后10、20、30min及气腹解除后10min各时点HR、MAP、PetCO2、PaCO2、PaO2、SpO2和ECG变化。结果建立CO2气腹后：HR逐步加快，MAP先升高后下降，PetCO2逐步增高，PaCO2逐步增高与气腹前比较差异有显著性（P〈0．05）；气腹前后PaO2和SpO2变化差异无显著性（P〉0.05）。结论新生儿腹腔镜手术中CO2气腹对呼吸和循环系统影响较明显。采用静脉全麻PCV模式控制呼吸的方法，有利于对新生儿呼吸和循环的管理。

Objective To observe the influences of artificial pneumoperitoneum on respiration and circulation of neonates , investigate the anesthetic methods of laparoscopic surgery in neonates and the management of respiration and circulation. Methods This study included 40 neonates scheduled to undergo laparoscopic surgery （aged 2 - 30d, weight 2- 5kg, ASA Ⅰ - Ⅱ ）. Total intravenous anesthesia and pressure controlled mechanical ventilation were performed in all neonates. The changes of HR, MAP, PetCO2 , PaCO2, PaO2 ,SpO2 and ECG were monitored continuously before pneumoperitoneum 10,20,30min after pneumoperitoneum and 10min after deflation. Results The HR, PetCO2 and PaCO2 gradually increased , MAP increased first and then decreased , which were significantly different from that before pneumoperitoneum （ P 〈 0.05 ）. There was no significant difference in PaCO2 and SpO2 before and after pneumoperitoneum （ P 〉 0.05 ） . conclusion CO2 pneumoperitoneum affected markedly the respiration and circulation of neonates during laparoscopic surgery. Total intravenous anesthesia and pressure control ventilation are benefical to the management of respiration and circulation of neonates.