艾司氯胺酮预处理联合低二氧化碳气腹压应用于腔镜疝气手术患儿的效果  

The Effect of Esketamine Pretreatment Combined with Low Carbon Dioxide Pneumoperitoneum Pressure in Pediatric Laparoscopic Hernia Surgery

作　　者：张雪莹 王晶涛[1] 杨卫[1] ZHAUNG Xue-ying;WANG Jing-tao;YANG Wei(Zhengzhou Second People's Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第二人民医院,河南郑州450000

出　　处：《黔南民族医专学报》2025年第1期4-8,共5页Journal of Qiannan Medical College for Nationalities

基　　金：河南省医学科技攻关计划联合共建项目(2018020744)。

摘　　要：目的:探讨艾司氯胺酮预处理联合低二氧化碳(CO _(2))气腹压应用于腔镜疝气手术患儿的效果。方法:以郑州市第二人民医院收治的81例接受腹腔镜疝气儿童为研究对象,按照随机数字表法将所有患儿分为A、B两组;术前A组和B组患儿均接受艾司氯胺酮预处理,术中B组(40例)CO _(2)气腹压力维持在10.0~12.0 mmHg,A组(41例)CO _(2)气腹压力维持在8.0~10.0 mmHg;比较两组患儿脑氧饱和度、呼吸力学参数、血气指标的变化以及镇静评分。结果:建立气腹10 min后、气腹解除10 min后A组和B组左、右脑氧饱和度均发生改变但是A组高于B组(P<0.05);建立气腹10 min后、气腹解除10 min后A组和B组呼气末二氧化碳分压、气道阻力、气道峰压以及气道平台压均发生改变但是A组低于B组(P<0.05);建立气腹前5 min、气腹即刻、建立气腹10 min后、气腹解除10 min后A组和B组PH值以及HCO 3-组间对比差异无显著性(P>0.05);A组首次出现疼痛、术后12、24、48 hVAS评分均低于B组(P<0.05)。结论:相比较于10.0~12.0 mmHg气腹压,8.0~10.0 mmHg的气腹压力可更好的维持患儿术中的脑氧饱和度、呼吸力学,降低术后膈肌的疼痛,且无论哪种气腹压力均不影响患儿的血气指标。Objective:To investigate the effect of esketamine pretreatment combined with low carbon dioxide(CO _(2))pneumoperitoneum pressure in pediatric laparoscopic hernia surgery.Methods:A total of 81 pediatric patients undergoing laparoscopic hernia surgery at Zhengzhou Second People's Hospital were enrolled and randomly divided into two groups,A and B,using a random number table.Both groups received esketamine pretreatment before surgery.During surgery,the CO _(2) pneumoperitoneum pressure was maintained at 10.0-12.0 mmHg in Group B(40 patients)and at 8.0-10.0 mmHg in Group A(41 patients).Changes in cerebral oxygen saturation,respiratory mechanics parameters,blood gas indices,and sedation scores were compared between the two groups.Results:Ten minutes after pneumoperitoneum establishment and ten minutes after pneumoperitoneum release,changes in left and right cerebral oxygen saturation were observed in both groups,but the values in Group A were higher than those in Group B(P<0.05).Ten minutes after pneumoperitoneum establishment and ten minutes after pneumoperitoneum release,changes in end-tidal carbon dioxide partial pressure,airway resistance,peak airway pressure,and plateau airway pressure were observed in both groups,but the values in Group A were lower than those in Group B(P<0.05).There were no significant differences in pH and HCO 3-levels between the two groups at 5 minutes before pneumoperitoneum,immediately after pneumoperitoneum,10 minutes after pneumoperitoneum,and 10 minutes after pneumoperitoneum release(P>0.05).The first occurrence of pain and VAS scores at 12,24,and 48 hours postoperatively were lower in Group A than in Group B(P<0.05).Conclusion:Compared with a pneumoperitoneum pressure of 10.0-12.0 mmHg,a pressure of 8.0-10.0 mmHg better maintains cerebral oxygen saturation and respiratory mechanics during surgery,reduces postoperative diaphragmatic pain,and neither pneumoperitoneum pressure affects blood gas indices in pediatric patients.

关 键 词：艾司氯胺酮 二氧化碳气腹 腹腔镜疝修补术 呼吸力学 血气 

分 类 号：R614[医药卫生—麻醉学]