低气腹压力腹腔镜手术对儿童局部肾氧饱和度的影响

Effect of low-pressure pneumoperitoneum in laparoscopic surgery on local renal oxygen saturation in children

目的探讨腹腔镜手术低气腹压力对儿童局部肾氧饱和度(Rr SO_2)的影响。方法选择2016年8月至2017年10月深圳市儿童医院择期行腹腔镜短小手术患儿80例为研究对象,按随机数表法分为低压组(1.33 k Pa)和高压组(1.87 k Pa),每组40例,观察两组患儿气腹前10 min(T0)、气腹中5 min(T1)、气腹中10 min(T2),停气腹后10 min(T3)的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO_2)、脑氧饱和度(Cr SO_2)、Rr SO_2等指标的变化,同时监测T0~T3时点肾功能指标,如尿素氮(BUN)、肌酐(SCr)、血清β2-微球蛋白(β2-MG)等,Pearson相关分析HR、DBP、Rr SO_2、SpO_2、Cr SO_2之间的相关性。结果两组患儿HR、SBP、SpO_2、Cr SO_2在T1、T2时点出现上升趋势,T3时点出现下降趋势,且两组患儿DBP、Rr SO_2在各时点比较差异均具有统计学意义(P<0.05);高气腹压组患儿Rr SO_2在T2时点明显低于低压组,差异具有统计学意义(P<0.05);低气压组和高气压组患儿BUN、SCr、β2-MG在T1、T2时点均出现上升(P<0.05),于T3时点处出现下降趋势,高压组BUN在T2时点明显高于低压组,差异具有统计学意义(P<0.05);Rr SO_2与Cr SO_2呈中度正相关(r=0.527,P<0.01),SpO_2与Rr SO_2、Cr SO_2无相关性。结论低二氧化碳气腹压力对患儿的肾氧饱和度和肾功能影响小,是腹腔镜气腹压力的最佳选择。

Objective To investigate the effect of low-pressure pneumoperitoneum（LP） in laparoscopic surgery on local renal oxygen saturation（Rr SO2） in children. Methods A total of 80 patients scheduled for laparoscopic surgery from Aug. 2016 to Oct. 2017 in Shenzhen Children＇s Hospital were chosen, which were randomly divided into low-pressure group（1.33 k Pa） and high-pressure group（1.87 k Pa）, with 40 patients in each group. Heart rate（HR）, systolic pressure（SBP）, diastolic pressure（DBP）, pulse oxygen saturation（Sp O2）, cerebral oxygensaturation（Cr SO2）,Rr SO2 and other indicators were observed 10 minutes before pneumoperitoneum（T0）, 5 minutes during pneumoperitoneum（T1）, 10 min（T2） during pneumoperitoneum, 10 minutes after pneumoperitoneum（T3）. Renal function indexes of urea nitrogen（BUN）, creatinine（SCr）, β2-microglobulin（β2-MG） changes were monitored at T0-T3. Pearson correlation was used to analyze the correlation between HR, DBP, and Rr SO2, Sp O2, Cr SO2. Results HR, SBP, Sp O2, Cr SO2 of low-pressure group and high-pressure group increased at T1 and T2, and then decreased at T3, and the differences between the two groups in DBP and Rr SO2 at each time point were statistically significant（P〈0.05）. Rr SO2 at T2 in high-pressure group was significantly lower than that of low-pressure group（P〈0.05）. BUN, SCr and β2-MG of the two groups were increased at T1, T2, decreased at T3, and BUN at T2 in high-pressure group was significantly higher than that of low-pressure group（P〈0.05）. A moderate positive correlation was found between Rr SO2 and Cr SO2（r=0.527, P〈0.01）. There was no correlation between Sp O2 and Rr SO2, Cr SO2. Conclusion Low-pressure carbondioxide pneumoperitoneum has little effect on renal oxygen saturation and renal function in children, and it is the best choice for laparoscopic pneumoperitoneum.