摘要
目的研究艾司氯胺酮预处理联合低二氧化碳(CO_(2))气腹压对腔镜疝气手术患儿术中神经、呼吸系统的保护作用。方法前瞻性选取2020年7月至2022年1月在淮北市妇幼保健院行腹腔镜小儿疝气高位结扎术治疗的患儿60例,按照随机数字表法分为2组,单组30例。所有患儿术前均给予0.50 mg/kg的艾司氯胺酮进行预处理,其中低腹压组术中CO_(2)气腹压力维持在8.0~10.0 mmHg,高腹压组术中CO_(2)气腹压力维持在10.1~12.0 mmHg。比较两种CO_(2)气腹压力下不同时间患儿的脑氧饱和度、呼吸力学参数、血气指标的变化,记录两组苏醒时间、Ricker镇静-躁动及Ramsay镇静评分。结果气腹建立前5 min(T0)和气腹即刻(T1)时,两组脑氧饱和度、呼吸力学参数比较,差异无统计学意义(P>0.05);气腹后10 min(T2)时,高腹压组的脑氧饱和度低于T0时,两组的呼气末二氧化碳分压(P_(ET)CO_(2))、气道阻力、气道峰压高于T0时,组间比较发现,低腹压组的脑氧饱和度高于高腹压组,呼吸力学参数低于高腹压组,差异均有统计学意义(P<0.05);气腹解除后10 min(T3)时,高腹压组的左脑氧饱和度低于T0时,呼吸力学参数高于T0时,同时组间比较发现,低腹压组的脑氧饱和度高于高腹压组,呼吸力学参数低于高腹压组,差异均有统计学意义(P<0.05)。两组在T0、T1、T2、T3时的pH值、碳酸氢根(HCO_(3)^(-))及苏醒时间、Ricker镇静-躁动、Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。结论艾司氯胺酮预处理联合低CO_(2)气腹压可平稳腔镜疝气手术患儿的脑氧饱和度和呼吸力学参数,保护神经、呼吸系统功能,对术后苏醒时间和麻醉镇静效果影响较小。
Objective To study the protective effect of esmketamine pretreatment combined with low carbon dioxide(CO_(2))pneumoperitoneum pressure on the nervous and respiratory system of children undergoing endoscopic hernia surgery.Methods Sixty children who underwent laparoscopic high ligation of pediatric hernia in Huaibei Maternal and Child Health Hospital from July 2020 to January 2022 were prospectively divided into two groups according to random number table method,30 cases in a single group.All children were pretreated with 0.50 mg/kg esmketamine before operation.The intraoperative CO_(2) pneumoperitoneum pressure was maintained at 8.0~10.0 mmHg in the low abdominal pressure group and 10.1~12.0 mmHg in the high abdominal pressure group.The changes of cerebral oxygen saturation,respiratory mechanics parameters and blood gas indexes of children under two kinds of CO_(2) pneumoperitoneum pressure at different times were compared,and the recovery time,Ricker sedation agitation and Ramsay Sedation score were recorded.Results There was no statistically significant difference in cerebral oxygen saturation and respiratory mechanics parameters between the two groups 5 minutes before the establishment of pneumoperitoneum(T0)and immediately after pneumoperitoneum(T1)(P>0.05);At 10 min after pneumoperitoneum(T2),when the cerebral oxygen saturation in the high abdominal pressure group was lower than T0,and the end expiratory carbon dioxide partial pressure(P_(ET)CO_(2)),airway resistance and peak airway pressure in the two groups were higher than T0,the comparison between the two groups found that the cerebral oxygen saturation in the low abdominal pressure group was higher than that in the high abdominal pressure group,and the respiratory mechanical parameters were lower than that in the high abdominal pressure group,the differences were statistically significant(P<0.05).At 10 min after pneumoperitoneum release(T3),the left cerebral oxygen saturation in the high abdominal pressure group was lower than T0,and the respiratory mechanics parameters were higher than T0;at the same time,the comparison between the groups showed that the cerebral oxygen saturation in the low abdominal pressure group was higher than that in the high abdominal pressure group,and the respiratory mechanics parameters were lower than that in the high abdominal pressure group,the differences were statistically significant(P<0.05).There were no statistically significant differences between the two groups in pH value,bicarbonate(HCO_(3)^(-))and recovery time,Ricker sedation agitation and Ramsay Sedation score at T0,T1,T2 and T3(P>0.05).Conclusion Esketamine pretreatment combined with low CO_(2) pneumoperitoneum pressure can stabilize the brain oxygen saturation and respiratory mechanics parameters of patients undergoing endoscopic hernia surgery,protect the functions of nerve and respiratory system,and have little effect on the postoperative recovery time and anesthetic sedation effect.
作者
杨鑫
朱免免
胡利
王幸星
YANG Xin;ZHU Mian-mian;HU Li(Huaibei Maternal and Child Health Hospital,Huaibei Anhui 235000,China)
出处
《临床和实验医学杂志》
2022年第11期1230-1232,F0003,共4页
Journal of Clinical and Experimental Medicine
基金
安徽省卫生健康委员会科研项目(编号:AHWJ2021b159)。
关键词
艾司氯胺酮
低二氧化碳气腹压
腹腔镜小儿疝气高位结扎术
脑氧饱和度
Esketamine
Low carbon dioxide pneumoperitoneum pressure
Laparoscopic high ligation of hernia in children
Cerebral oxygen saturation
