腹腔镜手术对婴幼儿呼吸、循环影响的临床研究

To explore the cardiorespiratory changes in infants undergoing laparoscopy.

目的比较婴幼儿腹腔镜与传统嵌顿疝手术在相同麻醉条件下对婴幼儿术中循环、呼吸的影响,为围术期麻醉管理提供依据。方法31例ASAI级腹股沟嵌顿性斜疝急诊手术患儿随机分为两组,其中16例行腹腔镜检+疝内容物还纳+疝囊超高位结扎术,简称为L组;另外15例行传统的疝内容物还纳+疝修补术,简称为O组。两组患儿均选择静吸复合、气管插管全麻。分别记录手术开始前5min(T1)、手术开始后10min(T2)、手术开始后20min(T3)和拔管后5min(T4)各时间点的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)和酸碱度(pH值)。结果组间比较显示T2、T3时两组间MAP、PaCO2和pH值的差异均有显著性意义(P<0.05)。L组的HR只在T3时高于O组(P<0.05)。T4时L组PaCO2较O组高(P<0.05)。结论对于没有合并症的ASAI级婴幼儿在严密监测下进行腹腔镜手术是可行的,但术中要注意气腹、体位改变和可能出现的二氧化碳蓄积对生理造成的影响。

Objective We compared the cardiorespiratory changes in infants undergoing either laparoscopy or laparotomy. Method Thirty-one children of ASA grade Ⅰ undergoing surgery for incarcerated inguinal hernia were randomly divided into 2 groups, laparoscopy group （L） （n = 16） and laparotomy group （O） （n = 15）, aged from 6 months to 2 years and 3 months. Under general anaesthesia, pneumoperitoneum was applied with carbon dioxide with an intra-abdominal pressure （IAP） of 10 mmHg. Heart rate （HR）, mean arterial pressures （MAP）, SaO2, PaCO2 and pH were recorded at 5 min before surgery （T1）, 10 min into surgery （T2）, 20 min into surgery （T3）, and 5 min after extubation （T4）. Results There were no surgical complications in two groups. HR in laparoscopy group increased at 10 min ＆ 20 min after surgery. HR and MAP were stable in laparotomy group during surgery. In the laparoscopy group, slight respiratory acidosis occurred at T2 and T3 （P〈 0. 05）. However blood gas analysis were stable in the laparotomy group. Conclusion We believe it is feasible to perform shorttime laparoscopy in infants undergoing general anaesthesia with rigorous monitor.