全凭静脉麻醉下小儿腹腔镜手术对呼吸循环系统影响

Ventilatory and hemodynamic changes in children during laparoscope surgery under total intravenous anesthesia

目的:观察全凭静脉麻醉下小儿腹腔镜手术对呼吸、循环系统的影响。方法:60例患儿按年龄分为3组:Ⅰ组,新生儿组;Ⅱ组,婴儿组;Ⅲ组,大于1周岁的患儿组,每组20例。患儿均采用气管插管丙泊酚、瑞芬太尼和阿曲库铵全凭静脉麻醉。麻醉期间行机械通气,分别于气腹前、气腹后10、30 min、腹腔放气后5 min及腹腔放气后10 min各时间点记录心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、气道峰压(Ppeak)、肺顺应性。结果:与气腹前比较,60例患儿的HR、SBP、DBP、Ppeak、PETCO2在气腹后都有所增高(P<0.05),SpO2和肺顺应性下降(P<0.05)。其中新生儿组和婴儿组改变明显。结论:腹腔镜手术对新生儿和婴儿呼吸、循环系统的影响较年长儿明显,故需加强围术期监测,确保安全。

Objective： To observe the ventilatory and hemodynamic changes in children undergcoing laparoscopic surgery under total intravenous anesthesia（TIVA）.Methods： Sixty children who required laparoscope surgery received total intravenous anesthesia.They were allocated to three age groups： neonates（groupⅠ,n=20）;infants（groupⅡ,n=20）;children more than 1 year of age（group Ⅲ,n=20）.The following haemodynamic and ventilatory variables were recorded： heart rate（HR）,blood pressure（BP）,peripheral oxygen saturation（SpO2）,end-tidal carbon dioxide（PETCO2）,peak inspiratory pressure（Ppeak） and lung compliance.Results： There were both ventilatory and hemodynamic changes in all groups after abdominal carbon dioxide insufflation： HR,BP,Ppeak and PETCO2 were increased;SpO2 and lung compliance were decreased.In group I and Ⅱ,the ventilatory and hemodynamic changes were significant.Conclusion： Laparoscopy surgery could affect the temporary ventilatory and hemodynamic in children.The changes of ventilatory and hemodynamic in newborns and infant undergoing laparoscope surgery are more obviously than in older children.