腹腔镜疝囊高位结扎术CO_2气腹对小儿呼吸、循环的近期影响  

Effect of CO_2 Aeroperitoneum on Children's Respiratory and Circulatory System During Laparoscopic Incarcerated Inguinal Hernia

作　　者：周太成[1] 杨劭宇[1] 罗宏图[1] 黄颖烽[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院普外科二区/胰脾外科,广东广州510180

出　　处：《临床医学工程》2013年第9期1143-1144,共2页Clinical Medicine & Engineering

摘　　要：目的探讨腹腔镜下疝囊高位结扎术中二氧化碳气腹对腹股沟斜疝患儿呼吸和循环的影响。方法选择2007年12月至2012年12月,我院行小儿腹腔镜下疝囊高位结扎术的患儿135例,术中建立气腹,维持压力于8~10 mm Hg,分别记录充气前、后5 min,充气后15 min,拔管后5 min,术后24 h五个时间段的心率（HR）、平均动脉血压（MAP）、呼气末二氧化碳分压（EtCO2）以及血气分析测定值（pH、PCO2、HCO3-）,并进行比较分析。结果手术平均气腹时间（20.6±4.3）min,平均气管插管拔管时间（52.3±6.7）min,术后住院平均（2.1±0.4）d。充气后HR和pH值有一定幅度的下降,MAP、EtCO2、PCO2和HCO3-值有所增加,术中维持稳定,各指标在拔管后迅速恢复并接近充气前水平。结论术中CO2吸收会出现轻度蓄积及酸中毒,并造成呼吸、循环系统病理生理指标的暂时变化,但恢复迅速。Objective To investigate the temporary effect of CO2 aeroperitoneum on the respiratory and circulatory system of children with inguinal hernia during laparoscopic ligation surgery,and evaluate the safety of CO2 aeroperitoneum in this surgery.Methods 135 children patients with inguinal hernia were operated with high ligation of hernial sac under laparoscopy,and all cases received CO2 aeroperitoneum during operation.The value of HR,MAP,EtCO2,blood pH,PCO2 and HCO3 were recorded in five different moments.Different groups of data were compared and analyzed.Results In total 135 cases,the average time for operation was（20.6 ± 4.3） minutes,for intratracheal intubation was（52.3 ± 6.7） minutes,and for hospitalization was（2.1 ± 0.4） days.After CO2 filled,patients demonstrated descending in HR and blood pH,while ascending in MAP,EtCO2,PCO2 and HCO3-.All these values recovered to normal level quickly after the tube removed.Conclusions With the absorption of CO2 during surgery,patients would have slight accumulation of CO2 and acid intoxication,which cause changes in respiratory and circulatory system.But all the influences are temporary.

关 键 词：二氧化碳气腹 疝囊高位结扎术 腹腔镜 影响 

分 类 号：R656.21[医药卫生—外科学]