婴幼儿腹腔镜手术二氧化碳气腹中容许性高碳酸血症的安全性探讨

Application of Permissive Hypercapnia on Pneumoperitoneum with Carbon Dioxide in Infants

目的探讨容许性高碳酸血症在婴幼儿腹腔镜手术二氧化碳气腹时麻醉中的安全性。方法腹腔镜下进行下腹部手术的患儿50例,ASAⅠ级,均气管内插管全身麻醉,机械通气下进行手术,根据PETCO2情况分为两组,每组25例。N组PETCO2≤6 kPa(45mmHg),H组PETCO2>6 kPa(45 mmHg),观察两组患儿循环、动脉血气的变化和术后恢复情况。结果气腹后两组患儿气腹持续时间、循环变化相同(P>0.05)。动脉血气变化:气腹后H组PaCO2升高(P<0.01),pH值下降(P<0.05);放气后10 min,pH值变化差异无统计学意义(P>0.05),H组PaCO2虽然有所升高(P<0.05),但已恢复至正常水平。手术结束至拔除气管导管的时间、患儿有哭闹或睁眼表现的时间两组间比较差异无统计学意义(P>0.05)。结论腹腔镜手术CO2气腹行机械通气呼吸管理时,对ASAⅠ级的婴幼儿,持续35 min轻度高碳酸血症不影响术后拔管和清醒时间。

Objective To research the application of permissive hypercapnia on pneumoperitoneum with carbon dioxide for infants undergoing laparoscopic surgery. Methods 50 infants with hypogastrium laparoscopic surgery at ASAI level without merger cardiopulmonary diseases were chosen. All the infants were operated with tracheal intubation intravenous general anesthesia, and the operation was controlled during mechanical ventilation. The cases were randomly divided into 2 groups at different PETCO2（group N,group H） ,and each group had 25 cases. [ PETCO2 ≤6 kPa（45 mmHg）in group N,PETCO2 〉6 kPa（45 mmHg）in group HI. The changes on circulation,blood gases and restoration after operation in the two groups were monitored. Results The duration of pneumoperitoneum and change of circulation of the infants wasnt different between the two groups（P 〉0.05）. The changes of arterial blood gas：compared with the group N,the infants of group H of PaCO2 increased obviously after penmnoperitoneum（P 〈0. 01 ）,and the pH value reduced obviously（P 〈0. 05）; In 10 minutes after deflation, the change of pH value wasn l different （P 〉 0.05 ）, the PaCO2 was higher in group H （P 〈0.05 ） ,but it had restored to normal levels. The time from the end of operation to windpipe canal removing,the time of infants crying,and opening eyes, there was no statistic difference between the two groups （P 〉 0. 05）. Conclusion The slight hypereapnia standing 35 minutes isnt affected the time of windpipe canal removing and revival after operation for the infants with ASA I level during the pneumoperitoneum with carbon dioxide on respiratory management of mechanical ventilation in infants undergoing laparoscopic surgery.