不同气腹压对腹腔镜手术患儿围手术期血气的影响

目的：探讨不同气腹压对腹腔镜手术患儿围手术期血气的影响,为患儿选择适宜的气腹压提供参考,以利于手术顺利进行。方法：收集腹腔镜手术患儿148例,根据年龄分为≤3岁组、4-6岁组、7-12岁组,并对每个年龄组随机分为3个亚组,每个亚组给予不同的气腹压。观察每个亚组间及相同气腹压情况下不同年龄患儿血气变化情况。结果：气腹时各年龄组不同气腹压亚组PetCO2、PaCO2、HR、MAP较气腹前明显升高（P〈0.05）,但在相同年龄组内较高气腹压亚组升高更明显（P〈0.05）,放气后15 min明显下降（P〈0.05）。在相同气腹压条件下,较小年龄的患儿在气腹时PetCO2、PaCO2、HR、MAP变化较明显。结论：在行小儿腹腔镜手术时,应根据年龄选择适宜气腹压,其中≤3岁患儿适宜气腹压为8 mmHg,4-6岁为10 mmHg,7-12岁为12 mmHg;如此既可满足手术视野需要,又可减少气腹对血气的影响并降低相关并发症的发生风险,确保手术顺利完成。

Effect on blood gas analysis of child patient treated with laparoscopic operation by different pneumoperitoneum pressure in operation period

Objective： To investigate the effect of blood gas of child patients who are treated with laparoscopic operation at different pneumoperitoneum pressure during operation period in ordor to obtain reference for selecting appropriate pneumoperitoneum pressure and to improve operation smoothly. Methods： 148 cases of child patients treated with laparoscopic operation were seleted,they were divided into≤3 years old group,4-6 years old group,7-12 years old group according to age,and each group was randomly divided into three sub groups,each sub group was given different pneumoperitoneum pressure. The blood gas changes among subgroup and between different age in same pneumoperitoneum pressure situations were observed. Results： The PetCO2,PaCO2,HR,MAP increased significantly compared with before pneumoperitoneum in different pneumoperitoneum pressure subgroups of each age group（ P 〈 0. 05）,but the increasing more obviously in higher pneumoperitoneum pressure subgroup in same age group（ P 〈 0. 05）,at 15 min after deflation they decreased significantly（ P 〈 0. 05）. The PaCO2,HR,PetCO2,MAP of smaller age children changed obviously in same pneumoperitoneum pressure conditions. Conclusion： In pediatric laparoscopic operation,the appropriate pneumoperitoneum pressure should be selected on basis of age,such as in children who are≤3 years old,the appropriate pneumoperitoneum pressure is 8 mmHg,in children who are 4-6 years old the pressure is 10 mmHg,in 7-12 years old the pressure is 12 mmHg. That can meet operationview and reduce effects on blood gas by pneumoperitoneum,reduce the risk of related complications,ensure operation completed successfully.