儿童腹腔镜阑尾切除术CO2气腹对呼吸的影响.DOCVIP

临床医学论文-儿童腹腔镜阑尾切除术CO2气腹对呼吸的影响 【摘要】? 目的：探讨儿童腹腔镜阑尾切除术（LA）CO2气腹对呼吸的影响。方法：47例小儿行LA，观察气腹前后PETCO2、SpO2、Ppeak的变化。结果：气腹后比气腹前患儿SpO2下降;而Ppeak、PETCO2上升。放气后PETCO2、SpO2、Ppeak基本恢复至气腹前水平。PETCO2气腹前后有显著差异，术终拔管前降至近气腹前水平。无低氧血症发生。结论：加强呼吸循环监测，术中合理用药，能使腹腔镜手术麻醉顺利完成，儿童腹腔镜手术将更安全可靠。 　　【关键词】? 阑尾切除术；气腹，人工；麻醉，静脉；腹腔镜；儿童 　　Effect of CO2 pneumopertoneum on respiration in laparoscopic appendectomy for children 　　【Abstract】? Ｏbjective:To investigate the effect of ＣＯ2 pneumoperitoneum on respiration in child laparoscopic appendectomy(LA).Methods:The PETCO2 ,SpO2 and Ppeak before and after pneumoperitoneum of 47 children undergoing LA were compared.Results:SpO２ decreased after pneumoperitoneum as compared with that before pneumoperitoneum,while Ppeak and PETCO2 increased.After deflation,PETCO2,SpO2 and Ppeak generally recovered to the level before pneumoperitoneum.The level of PET CO2 was significantly different before and after pneumoperitoneum,and it went down to the level before pneumoperitoneum before drawing the tube at the end of the operation. No hyoxemia occurred.Conclusions:Strentreing the respiratory and circulatory moritoning and paying attention to rational use of drug,anesthesia in LA will be more successfully and safely. 　　【Key words】? Appendectomy;Pneumoperitoneum,actificial;Anesthetics,intravenous;Laparoscopy;child ??? 微创手术是近年外科发展的新趋势，在小儿外科领域，腹腔镜随着各种器械的微型化而得以广泛应用。但腹腔镜手术须用的人工气腹,可导致小儿呼吸、循环神经内分泌等发生一系列生理改变。小儿腹腔容积小,腹膜吸收ＣＯ２快，对缺氧耐受差，易发生严重的生理紊乱。现将我院近年应用腹腔镜行小儿阑尾切除术的麻醉报道如下。 　　1? 资料与方法 　　１１? 临床资料? 本组患儿４７例行腹腔镜阑尾切除术（LA），ＡＳＡ Ｉ～Ⅱ级，其中男２８例，女１９例，３～１４岁，平均８岁。禁饮食６～８h，术前常规肌注阿托品００１５mg/kg,置胃管胃肠减压。 　　１２? 麻醉方法? 选用静脉麻醉，入室后开放静脉通路，静滴乳酸林格氏液１０～２０ml/kg，监测BP、HR、R、ECG、PETCO2、SpO2、Ppeak、T及尿量并记录。麻醉诱导用丙泊酚2～2.5mg/kg，维库溴铵0.1～0.15mg/kg，芬太尼3μg/kg。气管插管后接麻醉机控制呼吸，VT 8～10ml/kg，RR 14~20次/min，I:E为1:1.5～1:2.0,根据PETCO2调节呼吸机参数，使PETCO2维持在30～45mm Hg。术中麻醉维持丙泊酚静脉泵入，适时追加芬太尼、维库溴铵。以1～2L/min充气。气腹压力8～11mm Hg。术终自主呼吸、反射恢复良好，清醒后拔除气管导管。术后随访患儿有无呼吸异常等情况。 　　２? 结果 　　47例患儿采用静脉麻醉行LA，与气腹前比较,气腹后5min和15min患儿SpO2下降(P＜0.05）;而Ppeak上升(P＜0.05）。放气后5min PETCO2、S