腹腔镜Nissen胃底折叠术中患儿呼吸和循环功能的变化

Changes of respiratory and hemodynamic functions in children with laparoscopic Nissen's fundoplication

目的 观察腹腔镜Nissen胃底折叠术过程中不同年龄患儿的呼吸和循环功能的变化。方法 33例接受Nissen胃底折叠术的患儿按年龄分为三组。Ⅰ组（n=13）：1～12月；Ⅱ组（n=10）：1～3岁；Ⅲ组（n=10）：4～7岁。于气腹前5min（L）、气腹后10min（T1）、气腹后60min（T2）及停止气腹10min（T3），分别记录各组患儿的心率（HR）、平均动脉压、气道峰压（Ppeak）、呼吸系统静态总顺应性（CRS）、呼气末二氧化碳分压（PET CO2）和动脉二氧化碳分压（PaCO2）等血气分析指标。结果 与T0点比较，各组T1、T2点的HR、PET，CO2、PnCO2与PET，CO2的差值（Pa-ET，CO2）和Ppeak均显著增高，CRS显著降低，三组中Ⅰ组的变化最为显著。结论 在腹腔镜Nissen胃底折叠手术过程中，患儿的呼吸和循环功能均发生改变，其中1～12月龄患儿的变化最为显著，需加强麻醉管理。

Objective To observe the changes of respiratory and hemodynamic functions in children with different age underthree children with LNF were divided into three groups accgoing laparoscopic Nissen＇s fundoplication （LNF）. Methods Thirty-ording to the age： group Ⅰ , 1 to 12 months, n =13; group Ⅱ , 1 to 3 years old, n =10; and group Ⅲ, 4 to 7 years, n = 10. Heart rate （HR） , mean arterial pressure, Ppeak, compliance of the respiratory system （CRS） and end-tidal carbon dioxide pressure （PrTCO2） were recorded 5 min before pneumoperitoneum（ T0） , 10 min（ T1 ） , 60 min（ T2 ） after pneumoperitoneum and 10 min after deflation（T3） , and parameters of blood gas analysis such as P CO2 were measured at the same time. Results Compared with those at T0, HR, Ppeak, PETCO2 and the difference between P CO2 and PETCO2 （PETCO2） were significantly increased at T1 and T2, while CRS was significantly decreased. The most significant changes were found in group Ⅰ . Conclusion The changes of respiratory and hemodynamic functions are observed in children undergoing LNF, and anesthesia management should be enhanced for those within 1 to 12 months old who experience the most significant changes.