综合措施预防小儿外科腹腔镜手术中的高碳酸血症的研究  

Study on the Comprehensive Measures to Prevent the High Serum Levels of the Patients with Pediatric Surgical Laparoscopic Surgery

作　　者：叶宏立[1] 潘惠颜[1] 李日长[1] 张建华[1] 黄漫[1] 

机构地区：[1]江门市中心医院,广东江门529030

出　　处：《现代诊断与治疗》2015年第18期4081-4083,共3页Modern Diagnosis and Treatment

摘　　要：目的探讨采用过度通气和静脉注射碳酸氢钠等综合措施预防小儿外科腹腔镜手术中CO2气腹造成高碳酸血症的临床效果。方法选取于我院住院的行腹腔镜手术的患儿120例,随机分为A、B、C、D四组,采用全麻,设定使用相同的9~10mm Hg气腹压力,A组气腹一开始就进行过度通气进行麻醉干预;B组手术一开始静脉注射碳酸氢钠,术中按照正常呼吸通气参数进行通气,C组则同时采用术前注射碳酸氢钠和术中进行过度通气进行麻醉干预的方法;D组则不注射碳酸氢钠且术中按正常呼吸通气参数进行通气的麻醉方法。在术前5min、术中10min、术后10min进行血气分析监测,以p H和PCO2作为观测指标,对比四组病人术中、术后p H和PCO2,如P〈0.05则差异有显著性意义。结果 （1）A、B、C、D四组相比较,A组、B组均出现1例高碳酸血症患儿,发生率均为3.3%,C组未出现高碳酸血症,D组出现2例高碳酸血症患儿,发生率为6.7%。C组综合干预组高碳酸血症的发生率明显低于未干预及其他干预组,差异有统计学意义（P〈0.05）。（2）四组不同时间段p H值比较四组相比较,术中p H值均下降,术后四组均有所上升,但均为达到术前水平,C组升高更明显,a P〈0.05,b P〈0.05,c P〈0.05;b P〈0.05;A、B两组相比较,无明显统计学意义,e P〉0.05,A、B组与D组相比较,p H明显术后升高更明显,d P〈0.05。四组不同时间段PCO2值相比较,术中PCO2值均有所升高,术后均有所下降,C组与其他组相比较,术中升高较少,恢复较快,具有统计学意义,a P〈0.05,b P〈0.05,c P〈0.05;A、B两组相比较,无明显统计学意义,e P〉0.05,A、B组与D组相比较,p H明显术后升高更明显,d P〈0.05。结论综合措施预防小儿外科腹腔镜手术中的高碳酸血症临床效果明显,更利于手术的顺利进行及术后的恢复,临床具有指导意义,值得临床推广。Objective To study the and other comprehensive measures using excessive ventilation and to prevent pediatric surgery of intravenous sodium bicarbonate CO2 pneumoperitoneum laparo- scopic surgery causes hypercapnia clinical effect.Methods To select in our line of laparoscopic surgery in hospital, 120 cases of children, were randomly divided into A,B,C,D four groups, using general anesthesia, set to use the same 9~10mmHg pneumoperitoneum pressure, group A pneu- moperitoneum hyperentilation anesthesia intervention from the start, group B surgery first intra- venous sodium bicarbonate, intraoperative according to normal breathing ventilation parameters for ventilation, group C at the same time adopt preoperative injection of sodium bicarbonate and in- traoperative anesthetic intervention for excessive ventilation method, group D was not injection of sodium bicarbonate and intraoperative according to normal breathing ventilation parameters venti- lation method of anesthesia.5 min before surgery, intraoperative 10 min, 10 min after operation in monitoring blood gas analysis, pH and PCO2 as observation indexes, compare the four groups of patients, intraoperative and postoperative pH and PCO2, such as P〈0.05, differences are signifi- cant.Results （1）A,B,C,D four groups, group A and group B in 1 case for children with hypercap- nia occurence rate is 2.5%,not present hypercapnia group C, group D in 2 cases of children with hypercapnia, rate of 5%.The incidence＂ of comprehensive intervention group hypercapnia group C was lower than that in group without intervention and other intervention, the difference was statis- tically significant （P〈0.05）.Period （2） four groups of different pH value comparison, in comparison with four groups of pH value decreased, the four groups increased postoperatively, but all is up to the level of the preoperative, group C rise more apparent, the aP〈0.05,bP〈0.05,cP〈0.05;bP〈 0.05;Compared with A, B two groups, no significant statistical significance, eP〉0.05, A and grou

关 键 词：腹腔镜手术 高碳酸血症 碳酸氢钠 

分 类 号：R726[医药卫生—儿科]