全凭静脉麻醉下小儿腹腔镜手术对呼吸循环系统影响

目的：观察全凭静脉麻醉下小儿腹腔镜手术对呼吸、循环系统的影响。方法：60例患儿按年龄分为3组：Ⅰ组,新生儿组;Ⅱ组,婴儿组;Ⅲ组,大于1周岁的患儿组,每组20例。患儿均采用气管插管丙泊酚、瑞芬太尼和阿曲库铵全凭静脉麻醉。麻醉期间行机械通气,分别于气腹前、气腹后10、30 min、腹腔放气后5 min及腹腔放气后10 min各时间点记录心率（HR）、收缩压（SBP）、舒张压（DBP）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、气道峰压（Ppeak）、肺顺应性。结果：与气腹前比较,60例患儿的HR、SBP、DBP、Ppeak、PETCO2在气腹后都有所增高（P〈0.05）,SpO2和肺顺应性下降（P〈0.05）。其中新生儿组和婴儿组改变明显。结论：腹腔镜手术对新生儿和婴儿呼吸、循环系统的影响较年长儿明显,故需加强围术期监测,确保安全。

Ventilatory and hemodynamic changes in children during laparoscope surgery under total intravenous anesthesia

Objective: To observe the ventilatory and hemodynamic changes in children undergcoing laparoscopic surgery under total intravenous anesthesia(TIVA).Methods: Sixty children who required laparoscope surgery received total intravenous anesthesia.They were allocated to three age groups: neonates(groupⅠ,n=20);infants(groupⅡ,n=20);children more than 1 year of age(group Ⅲ,n=20).The following haemodynamic and ventilatory variables were recorded: heart rate(HR),blood pressure(BP),peripheral oxygen saturation(SpO2),end-tidal carbon dioxide(PETCO2),peak inspiratory pressure(Ppeak) and lung compliance.Results: There were both ventilatory and hemodynamic changes in all groups after abdominal carbon dioxide insufflation: HR,BP,Ppeak and PETCO2 were increased;SpO2 and lung compliance were decreased.In group I and Ⅱ,the ventilatory and hemodynamic changes were significant.Conclusion: Laparoscopy surgery could affect the temporary ventilatory and hemodynamic in children.The changes of ventilatory and hemodynamic in newborns and infant undergoing laparoscope surgery are more obviously than in older children.