摘要
目的观察小儿腹腔镜下肝门空肠吻合术中，动脉血CO2分压（PaCO2）与呼气末CO2分压（PETCO2）差值（Pa-ETCO2）的变化及其临床意义。方法胆总管囊肿患儿22例，均于腹腔镜下行肝门空肠吻合术。手术经历气腹-非气腹-再气腹过程，术中机械通气PCV模式，维持PETCO2 30—40mmHg。于气腹前5min，首次气腹后10、60min，气腹撤销后10、30、60min，再次气腹后10、60、90min以及再次气腹撤销后10min行动脉血气分析，计算每个时点的Pa-ETCO2。结景两次气腹后各时点及两次气腹撤销后10min，患儿的PETCO2与PaCO2较基础时点显著增高（P〈0．01）；在两次气腹后60min以及两次气腹撤销后10min，PaETCO2较气腹前显著增大（P〈0．05）。结论胆总管囊肿患儿腹腔镜下行肝门空肠吻合术中，在两次气腹后60min及两次气腹撤销后10min，PETCO2不能正确反映PaCO2，需进行血气分析测定该时点的PaCO2，以确保其处于正常范围。
Objective To investigate the change of difference between arterial carbon dioxide pressure（PaCO2） and end-tidal carbon dioxide pressures（ PETCO2 ） （ Pa-ETCO2 ） at different time points in infants with laparoscopic portojejunal anastomosis. Methods Twenty-two patients with choledochalcyst undergoing laparoscopic portojejunal anastomosis were selected. The process of pneumoperitoneumdeflation -pneumoperitoneum was experienced. PCV mode was used for mechanical ventilation during the operation, and PETCO2 was maintained at 30 to 40 mmHg. PaCO2 and PETCO2 were measured 5 rain before pneumoperitoneum, 10 and 60 rain after first pneumoperitoneum, 10, 30 and 60 rain after first deflation, 10, 60 and 90 rain after second pneumoperitoneum and 10 rain after second deflation. Pa-ETCO2 was calculated at each time points. Results Compared with those before pneumoperitoneum, PaCO2 and PETCO2 increased significantly after pneumoperitoneum and 10 rain after deflation （P 〈 0.01 ） , and Pa-ETCO2 increased significantly at 60 rain after both pneumoperitoneum （P 〈 0.05） and 10 min after both deflation（ P 〈 0.05 ）. Conclusion For infants with choledochalcyst undergoing laparoscopic portojejunal anastomosis, at 60 rain after both pneumoperitoneum and 10 rain after both deflation, PETCO2 may not be a perfect index of PaCO2. It is necessary to conduct blood gas analysis at these time points and take steps to maintain PaCO2.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2007年第9期1124-1126,共3页
Journal of Shanghai Jiao tong University:Medical Science
基金
上海市科委基金(054119570)(Shanghai Science and Technology Committee Foundation
054119570)
关键词
小儿
腹腔镜
肝门空肠吻合术
气腹
二氧化碳分压
infant
laparoscopy
portojejunal anastomosis
pneumoperitoneum
carbon dioxide pressure
