二氧化碳气腹对不同年龄小儿呼吸功能的影响

Effect of CO_2 peumoperitoneum on respiratory function of different aged child

目的观察二氧化碳气腹对不同年龄小儿呼吸功能的影响。方法将择期行腹腔镜手术患儿45例,根据年龄不同分为A组(婴儿组)、B组(幼儿组)、C组(学龄前组)三组,每组15例。所有患儿均行气管插管全麻,全程机械通气下进行手术。监测三组患儿动脉血气、呼吸力学的变化,并记录手术结束至拔除气管导管的时间、患儿表现哭闹或睁眼的时间。结果与气腹前5 min比较,气腹后15 min、30 min、45 min三组患儿的PaCO2均显著升高(P<0.01),pH值显著降低(P<0.01),A、B两组PaCO2>45 mmHg,pH值<7.35;气腹后三组患儿肺顺应性均显著降低(P<0.01)、气道峰压均显著升高(P<0.01);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三组间比较差异无统计学意义(P>0.05)。结论二氧化碳气腹对不同年龄小儿呼吸功能的影响不一,年龄越小对呼吸的影响越大,越易引起高碳酸血症。

Objective To observe the effect of CO2 peumoperitoneum on respiratory function of different aged child.Methods 45 cases children with laparoscope operation at ASAⅠlevel were enrolled and divided into 3 groups：Group A（infant）,Group B（young baby）,and Group C（preschool child）,and each group had 15 cases.All the children were operated with tracheal intubation general anaesthesia,and ventilation by machine during the whole process.The change of arterial blood gas and respiratory mechanics were monitored.The time from operation finishing to windpipe canal remove,and the time of cry or the time of opening eyes were recored.Result Compared with the time at 5 minutes before pneumoperitoneum,the children′s PaCO2 increased obviously（P0.01） and pH value was reduced obviously（P0.01） in all 3 groups at 15,30,and 45 minutes after pneumoperitoneum.PaCO2 were higher than 45mmHg and pH value were lower than 7.35 in Group A and B.The children′s PC decreased obviously（P0.01）,and PIP increased clearly（P0.01） in all 3 groups after pneumoperitoneum.There was no statistical difference（P0.05） in the time of operation finishing to windpipe canal remove,children′ cry or opening their eyes between three groups.Conclusion CO2 pneumoperitoneum has different effect on respiratory function of different aged child.The younger is the infant,the greater is the effect on its respiratory function,and it is easier to cause hypercapnia.