小儿腹腔镜手术中高氧状态发生高碳酸血症危险临床研究.docVIP

小儿腹腔镜手术中高氧状态发生高碳酸血症危险临床研究 　　[摘要] 目的 探讨小儿腹腔镜手术中发生高氧状态下高碳酸血症的危险性及防治措施。方法 整群选择2013年6―12月在该院实施全麻下腹腔镜手术患者64例，其中小儿34例，成人30例，分别分成小儿组和成人组。记录两组患者气管插管后即刻（T0）、气腹后10 min（T1）、气腹后15 min（T2）、气腹结束后15 min（T3）时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SPO2）、呼气末二氧化碳分压（PETCO2）和气道压。 结果 与T0 比较，两组患者气腹后T1 、T2 时间点MAP升高，HR增快（P0.01）。在T1、 T2时间点的PETCO2小儿组明显高于成人组（P0.01），两组在T2 、T3时间点的PETCO2均低于T1时间点（P0.01）；插管后各时间点的气道压小儿组均较成人组高（P0.01），两组在T1、 T2 时间点的气道压均高于T0时间点（P0.01）。结论 小儿腹腔镜手术麻醉中气道压高，更易发生高碳酸血症，但通过调整呼吸参数可避免高碳酸血症的发生，提高了小儿腹腔镜手术麻醉的安全性。 　　[关键词] 小儿腹腔镜手术；高氧状态；高碳酸血症 　　[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2015）11（c）-0112-03 　　[Abstract] Objective To explore the clinical effect of laparscopic carbon dioxide（CO2） pneumoperitoneum on infants respiratory， and the strategies on hypercapnia under the condition of high oxygen. Methods 64 patients undergoing laparoscopic surgery were choosed in 2013 from 6 month to 12 month at our hospital，and group children was 34 patients，group adult was 30 patients. Recording the change of mean arterial pressure（MAP），heart rate（HR），the saturation of pulse oxygen（SPO2），carbon dioxide partial pressure in endexpiratory gas（PETCO2） and airway pressure at immediate intubation（T0），10 minutes after CO2 pneumoperitoneum（T1），15 minutes after CO2 pneumoperitoneum（T2），and 15 minutes after pneumoperitonneum end （T3）. Results At T1 ，T2， the MAP and HR of two groups increased obviously compared with that T0 （P0.01） ， and the PetCO2 of group children was significant higher than that group adult（P0.01）. At T2 ，T3， the PETCO2 of two groups was lower than that T1（P0.01）. The airway pressure at after intubation ， group children was higher than that group adult （P0.01） . At T1 ，T2， the airway pressure of two groups increased obviously compared with that T0 （P0.01）. Conclusion When taking laparoscope operation on infants， airway pressure was easy higher that would cause hypercapnia， but those can be adjusted by the respiratory parameters，so as to avoid the happen of hypercapnia and increase the security.