小儿腹腔镜手术各年龄段适宜气腹压力的研究

目的 观察小儿各年龄段腹腔镜手术中,不同气腹压力下呼吸循环功能及血气指标的变化,找寻各年龄组小儿较为适宜的气腹压力.方法 将150例行腹腔镜手术的患儿按年龄分为三组:A组(1～3岁),B组(4～6岁),C组(7～12岁).各年龄组再按气腹压力设置的不同分为两组,即A1(9mm Hg)、A2(11mm Hg);B1(11mm Hg)、B2(13mm Hg);C1(13mm Hg)、C2(15mm Hg),监测各组气腹前后不同时间点的呼吸循环及血气指标.结果 各组患儿气腹后呼气末CO2分压、气道压力、平均动脉压、心率、PaCO2明显高于气腹前,其中A2、B2、C2组增高较A1、B1、C1组更为明显(P<0.05).A、B、C三组小儿较适宜的气腹压力分别为9mm Hg,11mm Hg和13mm Hg.结论 应在满足腹腔镜手术需要的前提下选择较小的气腹压力,以降低气腹对小儿生理机能的影响.

Appropriate pneumoperitoneum pressure during laparoscopic surgery in infants and children at different ages

Objective To observe changes of cardiorespiratory function and blood gas analysis in different pneumoperitoneum pressure during age-specific pediatric laparoscopic surgery and to find a compatible pneumoperitoneum pressure for different age-specific children.Methods One hundred and fifty cases undergoing laparoscopic surgery were divided into three groups:A(1～3y),B(4～6y),C(7～12y).Each group was divided into two subgroups again by different pneumoperitoneum pressure:A1,A2,B1,B2,C1,C2.Monitoring the cardiorespiratory function and blood gas analysis in different time point before and after pneumoperitoneum.Results Compared with the baseline value,PETCO2,Paw,MAP,HR,PaCO2 significantly increased after peritoneal insufflation in each group.And the increase in A2,B2,C2 were more obvious than in A1,B1,C1 (P<0.05).The eligible pneumoperitoneum pressures for A,B,C were 9,11,13mm Hg respectively.Conclusion Using a compatible pneumoperitoneum pressure for different age-specific children can meet the requirement of operation and attenuate the interference with physiological function.