【作者】 洪云霞；

【导师】 胡智勇；

【作者基本信息】 浙江大学 ， 儿科学， 2008， 硕士

【摘要】 目的：研究不同的CO₂气腹压下婴儿腹腔镜手术呼吸力学和循环功能的影响。方法：30例ASAⅠ-Ⅱ级小于1岁婴儿拟行腹腔镜手术，随机分为2组，每组15例。A组：CO₂气腹压为8mmHg，B组：CO₂气腹压为12mmHg．所有患儿均在标准麻醉下进行。患儿入手术室后予基础麻醉MKA0．1ml／kg（每毫升MKA含氯胺酮20mg，咪唑安定2mg，阿托品0．1mg）肌注。入睡后开放静脉。麻醉诱导用：MKA0．05ml／kg、芬太尼10ug／kg、万可松0．1mg／kg静推，术中予0．75MAC的七氟醚吸入维持。病人在仰卧位下行手术，所有病人均予机械控制呼吸定容模式（潮气量10-12ml／kg，呼吸频率为24-28次／min）以保持正常的呼末二氧化碳分压。整个研究过程呼吸机参数不再调整。麻醉中予50／50的氧气和空气的混和气吸入。术中予15-20ml／kg／hr的复方林格氏液输注以补充生理需要量和术中丢失。气腹前5min、气腹后10min、放气后5min监测心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、肺顺应性（Cdyn）、气道阻力（Raw）、潮气量（VT）、呼吸频率（RR）、气道峰压（Ppeak）、气道平台压（Pplac）、呼吸末二氧化碳(P_ETCO2)、脉博氧饱和度（SpO2）及血气分析。结果：结果己总结在表1、2、3、4。（1）A组和B组呼末二氧化碳(P_ETCO₂)水平T1比T0有统计学意义（P<0．05），T2比T0有统计学意义（P<0．05）。A组和B组血气分析PH值及PaCO₂水平T1比T0有统计学意义（P<0．05）。A组和B组平均动脉压（MBP）及脉搏（HR）T1比T0无统计学意义（P>0．05），T2比T0无统计学意义（P>0．05）。A组和B组血气分析HCO3^-水平及PaO₂T1比T0均无统计学意义（P>0．05）。（2）A组肺顺应性（Cdyn）、气道阻力（Raw）、气道峰压（Ppeak）T1比T0无统计学意义（P>0．05），T2比T0无统计学意义（P>0．05）。（3）B组肺顺应性（Cdyn）、气道阻力（Raw）、气道峰压（Ppeak）T1比T0有统计学意义（P<0．05），T2比T0无统计学意义（P>0．05）。（4）A组和B组T0期P_ETCO2、Cdyn、Raw、Ppeak、MAP、HR及血气分析PH、PaCO2、HCO3^-、PaO2相比较无统计学意义（P>0．05）。A组和B组T1期Cdyn、Raw、Ppeak相比较有统计学意义（P<0．05），P_ETO2、MAP、HR及血气分析PH、PaCO2、HCO3^-、PaO2相比较无统计学意义（P>0．05）。结论：1 8mmHg和12mmHg CO₂气腹压均可引起肺顺应性下降，气道阻力、气道峰压和呼吸末二氧化碳分压升高。2 8mmHg比12mmHg气腹压对患儿呼吸和循环的影响小，在满足手术需要的前提下，我们应选择低气腹压。更多还原

【Abstract】 Objective: To observe and investigate the effects of infant respiration and circulation in laparoscopic surgery under different CO2 pneumoperitoneum pressure.Methods: Thirty ASAⅠ-Ⅱpatients less than 1 year of age underwent LCwere randomly divided into two groups with 15 patients in each group. The CO2 pneumoperitoneum pressure was set at 8 mmHg in the Group A.12mmHg in the Group B. All patients received a standardized anaesthetic. When they came into the operation room, the patients were anesthetized with intramuscular injection of MKA 0.1ml/kg （Ketamine 20mg/ml, Midazolam 2mg/ml, Atropine 0.1mg/ml）. Anaesthesia induction used MKA 0.05ml/kg, fentant 0.01mg/kg, norcuron 0.1mg/kg, and maintained with sevoflurane 0.75MAC. Surgery was performed in the supine position. All patients underwent mechanical ventilation using volume-controlled mode （initial tidal volume 10-12ml/kg; respiratory rate 24-28/min） to maintain normocapnia .General aneasthesia was maintained with an oxygen/air mixture of 50/50 .A basalⅣinfusion （15-20ml/kg/hr） of lactated Ringer’s solution was given to compensate for the fasting state and intraoperativ losses. BP、HR、SpO2、P_ETCO2、 PIP、VT、Cdyn、Raw、MV、Ppeak、Pplat were determined at the three time points: 5min before peritoneal insufflation （T₀）,10min after peritoneal insufflation （T₁）,5min after exsufflation（T₂）.Results : Results are summarized in Table 1、2、3、4.（1） The P_ETCO₂ leve in group A and group B at T₁ were no significantly different compared with those at T₀, At T₂ the P_ETCO₂ level in both groups were significantly different compared with those at T0.The PH and PaCO₂ levels in both groups at T₁ were significantly different compared with those at T₀.There were no significant changes in MAP and HR in both groups at T₁ and T₂.（2） The Cdyn、Raw、Ppeak levels in group A at T₁ were no significantly different compared with those at T₀. At T₂ those were no significant changes compared with those at T₀.（3） The Cdyn、Raw、Ppeak levels in group B at T₁ were significantly different compared with those at T₀. At T₂ those were no significant changes compared with those at T₀.（4） The P_ET CO2、Cdyn、Raw、Ppeak、MAP、HR、PH、PaCO2、PaO2、HCO₃^- levels in group A and group B at T₀ were no significantly different.The Cdyn、Raw、Ppeak levels in group B at T₁ have significantly different from group A.Conclusion:1 8mmHg and 12mmHg CO₂ pneumoperitoneum pressure both causedCdyn decrease , PetCO₂、Raw and Ppeak increase.2 8mmHg CO₂ pneumoperitoneum pressure is less likely to effect infant respiratory and hemodynamic than 12mmHg CO₂ pneumoperitoneum pressure. Lower CO₂ pneumoperitoneum pressure is more preferable can be satisfied performed.更多还原