20例儿童腹腔镜胆总管囊肿根治术麻醉管理分析

发布时间：2018-09-16 21:47

【摘要】：目的总结儿童腹腔镜先天性胆总管囊肿根治术的麻醉管理经验,探讨长时间气腹的安全性风险防范及应对措施。方法择期行腹腔镜胆总管囊肿根治术患儿20例,年龄2~6岁,ASA分级Ⅰ、Ⅱ级。麻醉诱导:咪唑安定0.05 mg/kg,芬太尼2μg/kg,丙泊酚2.50 mg/kg,顺式阿曲库铵0.15 mg/kg。维持:丙泊酚4~6 mg/(kg·h),瑞芬太尼0.2~0.5μg/(kg·min)及顺式阿曲库铵1.0μg/(kg·min),七氟醚0.5%~1.0%吸入。记录气腹前(T0)、气腹后30 min(T1)、气腹后1 h(T2)、气腹后3 h(T3)和术毕(T4)等时点的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(Sp O2)、动脉血二氧化碳分压(Pa CO2)、呼气末二氧化碳分压(PETCO2)与气道阻力(Paw)值的变化,并监测血糖和体温。结果与T0比较,T1~T3时患儿的PETCO2、Pa CO2及Paw明显升高,差异有统计学意义(P0.05)。HR在T1~T3时升高,差异有统计学意义(P0.05)。p H值逐渐下降,T3时点下降最明显(P0.05),血糖逐渐升高,与T0比较差异有统计学意义(P0.05)。结论儿童腹腔镜先天性胆总管囊肿根治术麻醉中需适当加深麻醉和过度通气,结合血气,调整呼吸参数及水电解质平衡,避免高碳酸血症。静吸复合麻醉能很好地维持血流动力学的稳定,恢复迅速安全,可大大降低术后不良反应的发生。
[Abstract]:Objective to summarize the anesthetic management experience of laparoscopic radical operation for congenital choledochal cyst in children, and to explore the safety risk prevention and countermeasures of long term pneumoperitoneum. Methods 20 children with laparoscopic choledochal cyst underwent laparoscopic choledochal cyst radical resection. Anesthesia induction: midazolam 0.05 mg/kg, fentanyl 2 渭 g / kg, propofol 2.50 mg/kg, cis atracurium 0.15 mg/kg. Maintenance: propofol 4 and 6 mg/ (kg h), remifentanil 0.5 渭 g / (kg min) and cis atracurium 1.0 渭 g / (kg min), sevoflurane 0.5% inhalation. The mean arterial pressure before pneumoperitoneum (T 0), 30 min after pneumoperitoneum (T 1), 1 h after pneumoperitoneum (T 2), 3 h after pneumoperitoneum (T 3) and after operation (T 4) were recorded. (MAP), heart rate, (HR), pulse oxygen saturation (Sp O2), arterial blood carbon dioxide partial pressure (Pa CO2), end expiratory carbon dioxide partial pressure (PETCO2) and airway were recorded. The change of resistance (Paw) value, And monitor blood sugar and body temperature. Results compared with T0, the PETCO2,Pa CO2 and Paw of children with T _ 1 / T _ 3 were significantly higher than that of T _ (0), the difference was statistically significant (P0.05) .HR increased in T1~T3, the difference was statistically significant (P 0.05). The decrease of T _ 3 was the most obvious (P0.05), and the blood glucose gradually increased. Compared with T0, the difference was statistically significant (P0.05). Conclusion it is necessary to deepen anesthesia and hyperventilation, combine blood gas, adjust respiratory parameters and water electrolyte balance, and avoid hypercapnia during laparoscopic radical operation of congenital choledochal cyst in children. Combined intravenous anesthesia can maintain hemodynamic stability, recover quickly and safely, and can greatly reduce the occurrence of postoperative adverse reactions.
【作者单位】：南京医科大学附属南京儿童医院麻醉科;
【分类号】：R726.1

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