全麻低潮气量通气用于小儿胸腔镜辅助漏斗胸矫治术的临床观察

Clinical observation of video-assisted thoracic surgery bygeneral anesthesia with low tidal volume artificial ventilation in children with funnel chest

目的观察小儿胸腔镜辅助漏斗胸矫治术麻醉时采用低潮气量人工通气对于呼吸和循环的影响。方法以40例行胸腔镜辅助漏斗胸矫治术患儿作为研究对象,其中20例采用全麻低潮气量通气(观察组),另20例采用全麻常规潮气量通气(对照组),术中连续监测MAP、HR、CVP、SpO2、PCO2、PAW及PaO2等循环呼吸指标,记录气T0、T1、T2、T3及T4时上述各参数值并进行统计分析。结果观察组气道压力在人工气胸形成后5min、10min和30min时均较气胸形成前显著增加(P<0.05),两组PCO2在人工气胸形成后10min和30min时均较气胸形成前显著增加(P<0.05),且组间比较差异有统计学意义(P<0.05);观察组和对照组PaO2在人工气胸形成后10min和30min时均较气胸形成前显著降低(P<0.05),但组间比较差异无统计学意义。两组患儿MAP、CVP在人工气胸形成后5min、10min和30min时均较气胸形成前显著增加(P<0.05),但组间比较差异无统计学意义(P>0.05);两组患儿SpO2和HR在各时间点均无显著变化,组内、组间比较差异均无统计学意义(P>0.05)。观察组手术时间明显短于对照组,组间比较差异有统计学意义(P<0.05)。结论全麻下低潮气量人工通气用于小儿胸腔镜辅助漏斗胸矫治术是安全可行的。

Objective To observe the breathing, circulation parameters change in video-assisted thoracic surgery by anes- thesia with low tidal volume artificial ventilation in children with funnel chest. Methods ＇look 40 cases of funnel chest who re- ceived video-assisted thoracic surgery as study subjects, in which, 20 cases received general anesthesia with low tidal volume artl- fieial ventilation as study group and another 20 eases received general anesthesia with common tidal volume artificial ventilation as control group, the circulatory and respiratory indicators such as MAP, HR, CVP, Sp02, CO2, PCO2, PAW and PaO2 ,TO ,T1, T2 ,T3 and T4 were recorded and analysed. Results The PAW of the study group in T1,T2 and T3increased s!gnificantly com- pared with T0 （P 〈 0. 05 ）, the PCO： in T2 and T3of both groups increased significantly compared with To （P 〈0. 05 ）, and there were statistical difference between groups（ P 〈 0..05 ）, the PaO2of both groups in T2 and T3deereased significantly compared with To （ P 〈 0.05 ）, but there was no statistical difference between groups. The MAP and CVP of both groups in T1,T2 and T3 of both groups increased significantly compared with To （P 〈 0. 05 ）, but there were no statistical difference between groups（ P 〉 0. 05 ）, The SpO2 and HR of both groups had no significant change in every time point, and there was no statistical difference between groups. The operation time of study group was significantly shorter than the control group（P 〈0. 05 ）. Conclusion The video-as- sisted thoracic surgery by general anesthesia with low tidal volume artificial ventilation in children with funnel chest is safe and fea- sible.