腹腔镜手术中CO_2气腹对小儿呼吸循环的影响
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摘要
目的探讨腹腔镜手术中二氧化碳(CO_2)气腹对小儿呼吸循环的影响。方法选择2017年1月至2018年1月行腹腔镜手术患儿47例,监测患者腹腔镜手术中气腹前后的呼吸循环情况和血气指标变化,总结CO_2气腹对患儿呼吸循环的影响。结果患儿气腹后15 min和气腹后30 min的舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、血氧饱和度(SaO_2)和呼吸末CO_2值(P_(ET)CO_2)均比气腹前升高,而气腹后30 min的对应值比气腹后15 min的对应值下降,撤销气腹后10 min的对应值比气腹后30 min的值下降,气腹后和气腹前相比,组间比较差异有统计学意义(P<0.05);HR气腹前、气腹后15 min、气腹30 min后和撤销气腹后10 min的值逐渐升高,气腹后和气腹前相比,组间比较差异有统计学意义(P<0.05);患儿气腹后的pH值、PO_2和SaO_2较气腹前减小,PCO_2和HCO~-_3气腹后的值比气腹之前上升,气腹前后均有变化,气腹后和气腹前相比,组间比较差异有统计学意义(P<0.05)。结论在腹腔镜手术过程中CO_2气腹对小儿呼吸循环有不同程度的影响,气腹撤销后能够逐渐恢复。
Objective To investigate the effects of carbon dioxide(CO_2) pneumoperitoneum on respiratory circulation in children undergoing laparoscopic surgery.Methods A total of 47 children who underwent laparoscopic surgery in our hospital from January 2017 to January 2018 were enrolled in the study. The changes of respiratory circulation and blood gas indexes before and after pneumoperitoneum were monitored,and the effects of CO_2 pneumoperitoneum on respiratory circulation in children were analyzed.Results The diastolic blood pressure(DBP),mean arterial pressure(SBP),mean arterial pressure(MAP),oxygen saturation(SaO_2) and end-respiratory CO_2(PETCO_2) at 15 m andat 30 m after pneumoperitoneum in chidren patients were increased,as compared with those before pneumoperitoneum,however, the corresponding value at 30 minutes after pneumoperitoneum was lower than that at 15 minutes after pneumoperitoneum,and the corresponding value at 10 minutes after pneumoperitoneum was lower than that at 30 minutes after pneumoperitoneum,there was significant difference before pneumoperitoneum and after pneumoperitoneum(P<0.05). The levels of HR were gradually increased in order before pneumoperitoneum,at 15 m,30 m and at 10 m after pneumoperitoneum,there were significant differences before pneumoperitoneum and after pneumoperitoneum(P<0.05).As compared with those before pneumoperitoneum,the levels of PH,PO_2 and SaO_2 were decreased after pneumoperitoneum,however,the levels of PCO_2 and HCO3 were significantly increased, there were significant differences before pneumoperitoneum and after pneumoperitoneum(P<0.05).Conclusion The CO_2 pneumoperitoneum has effects at different extents on respiratory circulation in children patients during laparoscopic operation,but the effects may disappear gradually after pneumoperitoneum is withdrawn.
Objective To investigate the effects of carbon dioxide(CO_2) pneumoperitoneum on respiratory circulation in children undergoing laparoscopic surgery.Methods A total of 47 children who underwent laparoscopic surgery in our hospital from January 2017 to January 2018 were enrolled in the study. The changes of respiratory circulation and blood gas indexes before and after pneumoperitoneum were monitored,and the effects of CO_2 pneumoperitoneum on respiratory circulation in children were analyzed.Results The diastolic blood pressure(DBP),mean arterial pressure(SBP),mean arterial pressure(MAP),oxygen saturation(SaO_2) and end-respiratory CO_2(PETCO_2) at 15 m andat 30 m after pneumoperitoneum in chidren patients were increased,as compared with those before pneumoperitoneum,however, the corresponding value at 30 minutes after pneumoperitoneum was lower than that at 15 minutes after pneumoperitoneum,and the corresponding value at 10 minutes after pneumoperitoneum was lower than that at 30 minutes after pneumoperitoneum,there was significant difference before pneumoperitoneum and after pneumoperitoneum(P<0.05). The levels of HR were gradually increased in order before pneumoperitoneum,at 15 m,30 m and at 10 m after pneumoperitoneum,there were significant differences before pneumoperitoneum and after pneumoperitoneum(P<0.05).As compared with those before pneumoperitoneum,the levels of PH,PO_2 and SaO_2 were decreased after pneumoperitoneum,however,the levels of PCO_2 and HCO3 were significantly increased, there were significant differences before pneumoperitoneum and after pneumoperitoneum(P<0.05).Conclusion The CO_2 pneumoperitoneum has effects at different extents on respiratory circulation in children patients during laparoscopic operation,but the effects may disappear gradually after pneumoperitoneum is withdrawn.
引文
1 董泾青,刘茂玲,罗伟观.经脐单部位腹腔镜手术与传统手术治疗小儿鞘状突未闭的对照研究.实用医学杂志,2013,25:2120-2123.
2 谢春玲,李淑娟,赵晓余.医用二氧化碳的特点与实际应用效果分析.医用气体工程,2017,2:33-34.
3 毛常青,曹清勇,曾志民,等.小儿腹腔镜阑尾切除术CO2气腹对呼吸的影响.疑难病杂志,2013,12:90-91.
4 刘世江,孙杰,于颖颖,等.经皮二氧化碳监测在肥胖患者行腹腔镜胃旁路术中的应用.临床麻醉学杂志,2016,32:1064-1067.
5 史枢龙,宋志永.腹腔镜与传统腹股沟斜切口手术治疗小儿嵌顿性腹股沟斜疝的对比研究.中国普通外科杂志,2016,25:627-630.
6 文雯,兰志勋.CO2气腹对人体生理功能的影响及防治措施.实用医院临床杂志,2017,14:155-157.
7 张钰,王谊生,李剑,等.腹腔镜气腹期间呼吸参数对部分CO2重复吸入法监测的心输量影响.临床麻醉学杂志,2014,30:877-879.
8 卞则栋,何大维,刘星,等.腹腔镜肾盂输尿管成型术中CO2气腹对儿童机体酸碱平衡的影响.重庆医科大学学报,2014,38:80-83.
9 蒙炯,万智恒,祁凤灵.腹腔镜手术中二氧化碳气腹副作用的研究现状.中国伤残医学,2015,23:212-213.
10 罗中兵,张燕辉.腔镜手术导致二氧化碳栓塞的研究进展.医学综述,2015,21:2975-2978.
11 王芳.妇科腹腔镜手术后气腹相关并发症及护理.医药前沿,2014,36:248-249.
12 陈永权,付群,金孝岠.CO2气腹对心率变异性的影响.临床麻醉学杂志,2013,29:57-59.
13 王琳,孙震,吕晶.低水平呼气末正压通气对幼儿腹腔镜手术呼吸及循环功能的影响.临床麻醉学杂志,2016,11:187-188.
14 晁延军,李英,马富平,等.免气腹与CO2气腹在腹腔镜胆囊切除术中的临床对照研究.中华腔镜外科杂志电子版,2015,8:41-45.
15 陈茜,丁芳,陈永权.不同腹腔镜手术二氧化碳(CO2)气腹对患者呼吸动力学的影响.中国内镜杂志,2014,20:352-355.
2 谢春玲,李淑娟,赵晓余.医用二氧化碳的特点与实际应用效果分析.医用气体工程,2017,2:33-34.
3 毛常青,曹清勇,曾志民,等.小儿腹腔镜阑尾切除术CO2气腹对呼吸的影响.疑难病杂志,2013,12:90-91.
4 刘世江,孙杰,于颖颖,等.经皮二氧化碳监测在肥胖患者行腹腔镜胃旁路术中的应用.临床麻醉学杂志,2016,32:1064-1067.
5 史枢龙,宋志永.腹腔镜与传统腹股沟斜切口手术治疗小儿嵌顿性腹股沟斜疝的对比研究.中国普通外科杂志,2016,25:627-630.
6 文雯,兰志勋.CO2气腹对人体生理功能的影响及防治措施.实用医院临床杂志,2017,14:155-157.
7 张钰,王谊生,李剑,等.腹腔镜气腹期间呼吸参数对部分CO2重复吸入法监测的心输量影响.临床麻醉学杂志,2014,30:877-879.
8 卞则栋,何大维,刘星,等.腹腔镜肾盂输尿管成型术中CO2气腹对儿童机体酸碱平衡的影响.重庆医科大学学报,2014,38:80-83.
9 蒙炯,万智恒,祁凤灵.腹腔镜手术中二氧化碳气腹副作用的研究现状.中国伤残医学,2015,23:212-213.
10 罗中兵,张燕辉.腔镜手术导致二氧化碳栓塞的研究进展.医学综述,2015,21:2975-2978.
11 王芳.妇科腹腔镜手术后气腹相关并发症及护理.医药前沿,2014,36:248-249.
12 陈永权,付群,金孝岠.CO2气腹对心率变异性的影响.临床麻醉学杂志,2013,29:57-59.
13 王琳,孙震,吕晶.低水平呼气末正压通气对幼儿腹腔镜手术呼吸及循环功能的影响.临床麻醉学杂志,2016,11:187-188.
14 晁延军,李英,马富平,等.免气腹与CO2气腹在腹腔镜胆囊切除术中的临床对照研究.中华腔镜外科杂志电子版,2015,8:41-45.
15 陈茜,丁芳,陈永权.不同腹腔镜手术二氧化碳(CO2)气腹对患者呼吸动力学的影响.中国内镜杂志,2014,20:352-355.