气腹对胆道闭锁合并非紫绀型先天性心脏病患儿术中心功能的影响  

Effect of Pneumoperitoneum on Cardiac Function in Children with Biliary Atresia and Acyanotic Congenital Heart Disease

作　　者：胡一[1] 张道珍[1] 

机构地区：[1]深圳市儿童医院,广东深圳518038

出　　处：《现代医院》2016年第5期647-649,共3页Modern Hospitals

摘　　要：目的通过超声心动图评价气腹对胆道闭锁合并非紫绀型先天性心脏病(CHD)患儿术中心功能的影响。方法在限期行腹腔镜胆道闭锁胆道探查术的患儿中选取合并CHD的患儿20例(CHD组)、无CHD健康患儿20例(无CHD组),术中设定气腹压6 mm Hg,采用超声心动图观察两组患儿气腹前、气腹后的短轴缩短率(FS)、射血分数(LVEF)、二尖瓣舒张早、晚期峰值速率比值(E/A)、心肌做功指数(Tei值)等指标。结果 CHD组患儿气腹后LVEF和E/A均小于无CHD组,差异均有显著性(均P<0.01)。CHD组、无CHD组患儿气腹后各项心功能参数分别与其气腹前比较,均无显著性差异(均P>0.05),而气腹后HR、MAP均较其气腹前有所升高(均P<0.01)。结论胆道闭锁合并CHD患儿在行短时间腹腔镜手术,6 mm Hg的气腹压力是安全的。Objective To evaluate the effect of pneumoperitoneum on cardiac function in children with biliary atresia and acyanotic congenital heart disease by echocardiography. Methods Among the children who were going to undergo lapa- roscopic surgery for biliary atresia, 20 cases with CHD （ Group CHD） and 20 cases without CHD （ Group without CHD） were selected. During surgery, the iutra -abdominal pressure（IAP） was set as 6mmHg. Fractional shortening （FS） , left ventricular ejection fraction （LVEF） , E/A ratio （mitral early and late diastolic peak velocity ratio） and Tei value were observed by transthoratic echocardiography before and after pneumoperitoneum. Results After pueumoperitoneum, LVEF and E/A ratio in Group CHD were both statistically significantly lower than group without CHD （P 〈 0. 01 ）. Every cardiac function parame- ters after pneumoperitoneum were insignificantly different from those before pneumoperitoneum （ P 〉 0. 05 ） , but the levels of HR and MAP after pneumoperitoneum were significant higher than before pneumoperitoneum （ P 〈 0. 01 ）. Conclusion An intra - abdominal pressure（IAP） of 6 mmhg is safe during laparoscopie surgery for children with biliary atresia with CHD.

关 键 词：先天性心脏病 胆道闭锁 气腹 心功能 超声心动图 

分 类 号：R726.542[医药卫生—儿科]