摘要
目的分析小儿腹腔镜腹股沟疝手术中不同气腹压对血气指标、体内循环状况的影响。方法回顾性分析2015年3月至2016年4月,张家口市妇幼保健院收治的74例腹股沟疝患儿的临床资料,所有患儿均行小儿腹腔镜腹股沟疝手术治疗,依据术中采用的气腹压的不同将患儿分为低气腹压组及高气腹压组,每组患者37例。低气腹压组术中气腹压维持8 mm Hg(1 mm Hg=0.133 kPa),而高气腹压组维持12 mm Hg。检测并比较术前、气腹后10 min、30 min及放气后10 min患儿血气分析指标及循环指标的变化。结果与术前比较,气腹后10 min及30 min 2组气道压力(Paw)、呼气末二氧化碳分压(PetCO_2)、动脉二氧化碳分压(PaCO_2)及中心静脉压(CVP)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、心输出量(CO)及每搏输出量(SV)显著高于术前,且高气腹组显著高于低气腹组(P<0.01);放气后10 min 2组PetCO_2及PaCO_2仍显著高于术前,且高气腹组显著高于低气腹组(P<0.01),同时高气腹组SBP、DBP、MAP、CO及SVR显著高于术前,且SBP、DBP及CO仍显著高于低气腹组(P<0.05);与术前比较,气腹后10 min及30 min 2组胸廓顺应性(Cmpl)显著降低,且高气腹组显著低于低气腹组(P<0.05);与术前比较,低气腹组全血碱剩余(ABE)及标准碱剩余(SBE)均无显著变化(P>0.05),而气腹后30 min高气腹组ABE及SBE显著升高(P<0.05)。结论小儿腹腔镜腹股沟疝手术中高气腹压较低气腹压对患儿的血气及循环的影响大,因此临床应据实际情况尽量避免术中选择12 mm Hg以上的气腹压。
Objective To explore the effect of pediatric laparoscopic hernia surgery on the blood gas index and circulating parameters. Methods 74 cases chlidren with hernia in Zhangjiakou Maternity and Child Care from March 2015 to April 2016 were selected and all children were treated with pediatric laparoscopic hernia surgery. All child patients were divided into low pneumoperitoneum pressure group and high pneumoperitoneum pressure group according to the different of pneumoperitoneum pressure during operation, and 37 cases for each group. Intraoperative pneumoperitoneum pressure in low pneumoperitoneum pressure group maintained at 8 mm Hg, and high pneumoperitoneum pressure group maintained at 12 mm Hg. Detected and compared the blood gas index and circulating parameters preoperative, 10 min, 30 min after pneumoperitoneum and 10 min after deflated. Results The pneumoperitoneum time, pneumoperitoneum formation time and gas released time had no significant difference（P〉0.05）. Compared with pre-operation, the Paw, PetCO2, PaCO2 and CVP, SBP, DBP, MAP, HR, CO and SVR showed first increasing then decreasing trend. At 10 min and 30 min after pneumoperitoneum, those indicators were significantly higher in both two groups, and high pneumoperitoneum pressure group was higher than low pneumoperitoneum pressure group（P〈0.01）. The Paw, CVP and HR of 2 groups return to the preoperation level gradually at 10 min after deflated, and there was no significant difference between 2 groups（P〉0.05）. While the PetCO2 and PaCO2 at 10 min after deflated were higher than those in preoperation, and above indicators in high pneumoperitoneum pressure group were higher than those in low pneumoperitoneum pressure group（P〈0.01）. At the same time, the SBP, DBP, MAP, CO and SVR in high pneumoperitoneum pressure group were higher than preoperation level and SBP, DBP and CO were higher than those in low pneumoperitoneum pressure group. Compared with preoperation, the Cmp1 of 2 groups decreased significantly at 10 min and 30 min after pneumoperitoneum, and high pneumoperitoneum pressure group was higher than low pneumoperitoneum pressure group; the PaO2 and SaO2 had no significant changes（P〉0.05）; compared with preoperation, the ABE and SBE of low pneumoperitoneum pressure group had no significant changes（P〉0.05）, while the ABE and SBE of high pneumoperitoneum pressure group at 30 min after pneumoperitoneum increased significantly（P〈0.05）. The SV of 2 groups from pneumoperitoneum to 10 min after deflated had no significant changes（P〉0.05）. Conclusion High pneumoperitoneum pressure had a great influence on the blood gas index and circulating parameters in pediatric laparoscopic hernia surgery, so we should avoid 〉12 mm Hg pneumoperitoneum in clinic.
作者
刘永刚
Liu Yonggang(Department of Pediatric Surgery, Zhangjiakou Maternity and Child Care, Hebei 075000, Chin)
出处
《中华疝和腹壁外科杂志（电子版）》
2018年第2期94-98,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝
腹股沟
疝修补术
腹腔镜
血气分析
循环
Hernia,inguinal
Herniorrhaphy
Laparoscopes
Blood gas analysis
Circulation
