二氧化碳气腹对小儿腹腔镜手术期间无创脑氧饱和度的影响

Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children

目的应用近红外光谱监测局部脑氧饱和度(r SO_2),观察腹腔镜手术期间二氧化碳气腹对小儿r SO_2的影响。方法选择行腹腔镜下阑尾切除手术患儿40例。将脑氧监护仪的双侧电极对称贴于患儿额部,采集两侧数据取平均值。记录气腹前、气腹后30 min的r SO_2、Pa O_2、Pa CO_2、Pet CO_2、MAP、HR、Hb以及体温。结果与气腹前比较,Pa CO_2、Pet CO_2于气腹后30 min均显著性增加(P<0.05)。气腹前后,r SO_2、Pa O_2、Hb、HR、MAP、体温比较差异无统计学意义。结论腹腔镜阑尾切除手术CO_2气腹期间,虽二氧化碳分压增加,但气腹对脑氧饱和度会有影响。

Objective This study was designed to evaluate the changes of cerebral oxygen saturation using near- infrared spectroscope during laparoscopic surgery in children. Methods This study comprised forty children who were scheduled for laparoscopic appendectomy. Right and left regional cerebral oxygen saturation, Hemodynamic variables, PaO2 ,PaCO2 , PetCO2 , MAP, HR, Hb , body temperature were recorded. All Parameters were recorded before insufflation and 30min after start of insufflation. Results There were progressive increases in PaCO2 and PetCO2 , which were statistically significant after insufflation 30 min （ P 〈 0.05 ）. There were not statistically significant in rSO2 , HR, PaO2 , MAP, Hb , body temperature after insufflation 30 min. Conclusion Although Carbon dioxide pressure increases during laparoscopic appendectomy, rSO2 was not statistically changed, which may not prove pneumoperitoneum affect cerebral oxygenation under laparoscopic surgery.