幼儿腹腔镜手术时预防高碳酸血症的临床研究

The strategies of hyperearbia prevention during laparoscopic surgery for children

目的探讨幼儿腹腔镜手术时预防高碳酸血症的方案。方法选择接受腹腔镜手术，体征约10k左右患儿40例，随机将其分为A、B两组，设定使用相同的9mmHg气腹压力，A组改变呼吸通气参数提前进行麻醉干预，B组选择通常呼吸通气参数进行麻醉，观察末梢二氧化碳分压及心率改变，同时对比两组发生二氧化碳潴留的机率并记录两组相关数据。结果提前麻醉干预组术中血气二氧化碳分压、心率和呼末二氧化碳大致正常，而进行正常呼吸通气参数麻醉麻醉组血气二氧化碳分压、心率和呼末二氧化碳高于干预组（P〈0．05）。结论腹腔镜手术对小儿的呼吸、循环及血气虽有较大影响，但通过改变呼吸通气参数提前进行麻醉干预，对预防高碳酸血症有积极意义。

Objective To explore the schemes for hypercarbia prevention during laparoscopic surgery for children. Methods 40 children weighing about 10 kg and undergoing laparoscopic surgery were randomly divided into groups A and 8. The same 9mmHg pneumoperitoneum pressure was applied in the two groups. Anesthetic invention was performed beforehand with changed parameters for respiratory ventilation in group A; group B received anesthesia with routine parameters for ventilation. The changes in the peripheral carbon dioxide partial pressure and heart rate were observed. The rate of carbon dioxide retention was compared between the two groups. Results In intervention group, intraoperatlve anesthesia carbon dioxide partial pressure and heart rate were generally normal, but carbon dioxide partial pressure and heart rate was significantly higher in group B than in group A （P〈 0.01）. Conclusions Laparoscopic surgery has a greater impact on respiration, circulation, and blood-gas. It is of clinical significance for preventing hypercarbia by changing the parameters of respiratory ventilation for anesthetic intervention beforehand.