小儿腹腔镜手术气腹相关并发症发生的原因和护理

目的探讨小儿腹腔镜手术气腹相关并发症发生的原因,并提出相应的护理措施。方法回顾性分析120例行腹腔镜手术患儿的临床资料,总结气腹相关并发症发生的原因和预防措施。结果 120例腹腔镜手术患儿共发生气腹相关并发症16例,其中胃内容物反流6例、呼吸性酸中毒4例、体温下降3例、气管导管移位3例;无1例发生气胸、纵膈气肿、气体栓塞、心包积气等与气腹相关的严重并发症。结论采用最小的气腹压力是预防胃内容物反流、高碳酸血症和呼吸性酸中毒的主要措施,做好体位护理、固定好气管导管和注意保暖及使用加温的CO2充气对预防胃内容物反流、体温下降和气管导管移位的发生具有积极的意义。

Objective To explore the causes of pneumoperitoneum complications during pediatric laparoscopic surgery and to put forward the pertinent nursing measures.Method A retrospective analysis was conducted on 120 patients undergoing pediatric laparoscopic surgery,and the nursing measures of preventing pneumoperitoneum correlative complications were summarized.Results Sixteen patients had pneumoperitoneum correlative complications,including gastric contents back-streaming in 6 patients,respiratory acidosis in 4,temperature drop in 3 and shift of trachea duct in 3.No major pneumoperitoneum correlative complications happened,such as pneumothorax,mediastinal emphesema,gas embolism or pneumopericardium.Conclusions Using a minimal pneumoperitoneum pressure is the main nursing measure to avoid gastric contents back-streaming,hypercapnia and respiratory acidosis.Meanwhile,body position nursing,fixing the trachea duct,keeping body warm and using warming CO2 to aerate are important to prevent the incidence of gastric contents back-streaming,temperature drop and shift of trachea duct.