全身麻醉下腹腔镜胆总管囊肿切除术患儿的适宜吸入氧浓度

Optimal concentration of inhaled oxygen in pediatric patients undergoing laparoscopic choledochal cyst resection under general anesthesia

目的:确定全身麻醉下腹腔镜胆总管囊肿切除术患儿的适宜吸入氧浓度。方法:择期拟在全身麻醉下行腹腔镜胆总管囊肿切除术患儿75例,年龄1~3岁,性别不限,ASA分级Ⅱ或Ⅲ级,BMI 15~18 kg/m^(2),预计手术时间≥3 h。采用随机数字表法分为3组(n=25):C_(40)组(FiO_(2)=40%)、C_(30)组(FiO_(2)=30%)和C_(21)组(FiO_(2)=21%)。术毕抽取桡动脉血行血气分析,计算氧合指数(OI)、呼吸指数(RI)、肺泡动脉氧分压差(PA-aO_(2))和动脉肺泡氧分压比(PaO_(2)/PAO_(2));记录缺氧高风险事件(SpO_(2)<94%)发生情况、气管拔管时间、术后7 d肺炎和肺不张发生情况。结果:与C_(21)组比较,C_(30)组和C_(40)组PaO_(2)、PAO_(2)、PA-aO_(2)和RI升高,PaO_(2)/PAO_(2)降低,缺氧高风险事件发生率降低,术后7 d C_(30)组肺不张发生率、C_(40)组肺炎和肺不张发生率升高(P<0.05);与C_(30)组比较,C_(40)组PaO_(2)、PAO_(2)、PA-aO_(2)和RI升高,PaO_(2)/PAO_(2)降低(P<0.05)。结论:全身麻醉下腹腔镜胆总管囊肿切除术患儿的适宜吸入氧浓度推荐21%~30%。

Objective To determine the optimal concentration of inhaled oxygen in pediatric patients undergoing laparoscopic choledochal cyst resection under general anesthesia.Methods Seventy-five pediatric patients of both sexes,aged 1-3 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with body mass index of 15-18 kg/m^(2),with expected operation time≥3 h,scheduled for elective laparoscopic choledochal cyst resection with general anesthesia,were divided into 3 groups(n=25 each)using a random number table method:C_(40) group(FiO_(2)=40%),C_(30) group(FiO_(2)=30%)and C_(21) group(FiO_(2)=21%).Blood samples were collected from the radial artery for blood gas analysis after operation for determination of oxygenation index(OI),respiratory index(RI),alveolar-arterial oxygen partial pressure difference(PA-aO_(2))and arterial-alveolar oxygen partial pressure ratio(PaO_(2)/PAO_(2)).The occurrence of high risk events of hypoxia(SpO_(2)<94%),extubation time,and occurrence of pneumonia and atelectasis at day 7 after operation were recorded.Results Compared with C_(21) group,PaO_(2),PAO_(2),PA-aO_(2)and RI were significantly increased,PaO_(2)/PAO_(2)was decreased,and the incidence of high risk events of hypoxia was decreased in C_(30) and C_(40) groups,and the incidence of atelectasis in C30 group and pneumonia and atelectasis in C_(40) group was increased at day 7 after operation(P<0.05).Compared with C_(30) group,PaO_(2),PAO_(2),PA-aO_(2)and RI were significantly increased,and PaO_(2)/PAO_(2)was decreased in C40 group(P<0.05).Conclusions The optimal concentration of inhaled oxygen recommended is 21%-30%in the pediatric patients undergoing laparoscopic choledochal cyst resection under general anesthesia.