小儿腹腔镜手术最佳气腹压力与体表面积相关性的临床研究

Association between optimum pneumoperitoneum pressure and surface area of pediatric laparoscopic surgery

目的 探讨小儿腹腔镜手术中最佳气腹压力与体表面积的关系,提高小儿腹腔镜手术的安全性,降低腹腔镜手术气腹压力在术中或术后的并发症.方法 本组150例手术患儿,年龄0.5 ～8岁,随机分为3组,每组50例,按气腹压分别设置为A组（6～8mmHg）、B组（8.1～10 mmHg）、C组（10.1～12 mmHg）,监测气腹前和气腹后30 min的生命体征、血气分析、术野清晰度等.结果气腹前3组患儿SBP、DBP、HR和SpO2组间和组内比较差异均无统计学意义（P＞0.05）;气腹后30 min,C组患儿的收缩压、舒张压、心率均升高,血气分析结果显示pH、pO2降低,pCO2 、HCO3-升高,与A组、B组比较差异有统计学意义（P＜0.05）;气腹后30 min 3组患儿术野清晰度比较,B组患儿的术野清晰度中优级的例数最多,与A组、C组比较差异有统计学意义（P＜0.05）;对3组患儿气腹压力与体表面积、身高、体重进行相关分析,结果 显示无相关关系（P＞0.05）.结论 腹腔镜手术各年龄组体表面积设定的最佳气腹压力以8～ 10 mmhg组较好,能够满足手术视野和手术操作的需要,可减少CO2气腹对小儿机体循环和呼吸功能的影响,降低术中术后并发症的发生。

Objective To explore the association between optimum pneumoperitoneum pressure and surface area of pediatric laparoscopic surgery, and to enhance the surgical safety and reduce intraoperative and post-operative complications related to pneumoperitoneum pressure. Methods Pediatric laparoscopic surgery was performed in 150 children aged 0.5 to 8 years. According to the pneumopefitoneum pressure, 150 patients were equally divided into group A [ （6 - 8 ） mmHg, n = 50 ], group B [ （ 8.1 - 10） mmHg, n = 50 ] and group C [ （ 10.1 - 12） mmHg, n = 50 ]. The vital signs, blood gas analysis and clarity of operative field were moni- tored before and at 30 minutes after pneumoperitoneum establishment. Results Before pneumoperitoneum es- tablishment, there was no significantly difference in SBP, DBP, HR and SpO2 between three groups （P 〉 0.05）. At 30 minutes after pneumoperitoneum establishment, the heart rate, systolic pressure, diastolic pressure, pCO2 and HCOz - increased significantly and pH, pOz decreased in group C compared with group A and group B （P 〈 0.05）. At 30 minutes after pneumoperitoneum establishment, the clarity of operative field in group B was superior to that in group A and group C （P 〈 0.05）. Pneumoperitoneum pressure was not cor- related with surface area, height and weight （ P 〉 0.05 ）. Conclusions The optimum pneumoperitoneum pressure for pediatric laparoscopic surgery is 8 to 10 mmHg. This pneumoperitoneum pressure can satisfy the need of operative field and surgical manipulation, can reduce the impact of CO2 on circulation and breathing, and decrease the occurrence of post-operative complications.