实时超声评估小儿腹腔镜手术麻醉诱导后胃内进气量与喉罩正压通气的关系  

Evaluation of relationship between gastric air intake volume and positive laryngeal mask ventilation by real-time ultrasound during laparoscopic surgery in children after anesthesia induction

作　　者：关邵宇 张运淳[1] Guan Shaoyu;Zhang Yunchun(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院麻醉科,安徽蚌埠233004

出　　处：《齐齐哈尔医学院学报》2023年第14期1334-1337,共4页Journal of Qiqihar Medical University

摘　　要：目的 探究通过胃部超声监测腹腔镜手术的小儿患者麻醉诱导后与术后的胃窦的横截面积变化情况,为小儿腹腔镜手术患者选择麻醉诱导期和术中气道管理提供临床科学依据。方法 选择2021年10月—2022年4月本院择期全身麻醉下行腹腔镜疝囊高位结扎术的小儿患者60例作为研究对象,3~7岁,ASA分级Ⅰ级。所有患儿均按小儿腹腔镜手术全麻常规进行快速静脉诱导及15 cmH_(2)O压力面罩通气,按压力控制(PCV)模式下气道峰压(PIP)设定值随机分为三组:P15组(PIP 15 cmH_(2)O)、P17组(PIP 17 cmH_(2)O)和P19组(PIP 19 cmH_(2)O),每组均为20例。行机械通气,分别记录麻醉诱导前、诱导后及术后即刻超声下胃窦横截面积(CSA)、呼气末二氧化碳分压(PETCO_(2)),随访患儿术后24 h的恶心呕吐发生情况。结果 P19组患儿胃窦CSA显著增加,另两组无明显差异;P15组患儿PETCO_(2)高于P17组和P19组;P19组术后恶心呕吐发生率较另两组明显增加。结论 17 cmH_(2)O是小儿行腹腔镜手术的最佳压力控制通气压力,在该压力通气下可提供充足的呼吸潮气量,同时避免术中二氧化碳潴留及胃胀气的发生,降低患者术后出现恶心呕吐的可能。Objective To investigate the changes in the cross-sectional area of the gastric antrum of pediatric patients undergoing laparoscopic surgery by gastric ultrasound after anesthesia induction and after surgery,and provide a clinical basis for the selection of airway management during the anesthesia induction period and intraoperative period in laparoscopic surgery for pediatric patients.Methods Sixty pediatric patients who underwent elective laparoscopic high ligation of hernia sac under general anesthesia in our hospital from October 2021 to April 2022 were selected as the study objects,aged 3-7 years,ASA grade I.All children underwent rapid intravenous induction and 15 cm H_(2)O pressure mask ventilation before general anesthesia during pediatric laparoscopic surgery.The patients were randomly divided into three groups according to the set value of airway peak pressure(PIP)under pressure control(PCV)mode:Group P15(PIP 15cm H_(2)O),group P17(PIP 17cm H_(2)O)and group P19(PIP 19cm H_(2)O),with 20 patients in each group.Mechanical ventilation was performed,and the cross-sectional area(CSA)of gastric antrum and end-expiratory carbon dioxide pressure(PETCO_(2))under ultrasound were recorded before anesthesia induction,after anesthesia induction and immediately after surgery,respectively.The incidence of nausea and vomiting within 24 hours after surgery was followed up.Results Gastric antrum CSA increased significantly in P19 group,but there was no significant variation in the other two groups.PETCO_(2) in P15 group was higher than that in P17 and P19 group.The incidence of postoperative nausea and vomiting in P19 group was significantly higher than that in the other two groups.Conclusions 17cm H_(2)O is the best pressure control ventilation pressure for children undergoing laparoscopic surgery,which can provide sufficient tidal volume of respiratory volume,avoid the occurrence of intraoperative carbon dioxide retention and gastric flatulence,and reduce the possibility of postoperative nausea and vomiting.

关 键 词：胃部超声 小儿麻醉 压力通气 胃窦部横截面积 

分 类 号：R614.2[医药卫生—麻醉学]