摘要
目的评估不同气腹压力对腹腔镜疝囊高位结扎患儿围手术期恢复的影响。方法采用前瞻性随机对照的研究方法,将60例接受腹腔镜疝囊高位结扎的患儿随机分为3组。A组为常规气腹压力组(9 mm Hg)、B组为低气腹压力组(7 mm Hg)、C组为阶梯式气腹压力组(9 mm Hg^5 mm Hg)。观察并比较不同气腹压力下,建立气腹前10 min、建立气腹后10 min、手术结束时3个时间点患儿的生命体征、血气变化及术后疼痛情况。结果 3组患儿手术均顺利完成,无中转改开放手术,无围手术期并发症发生。气腹后10min各组内收缩压、舒张压较气腹前升高,手术结束时常规气腹压组收缩压及心率较气腹前升高(P<0.05);在建立气腹后10min及手术结束时各组间及组内脉血二氧化碳分压(Pa CO_2)、呼末二氧化碳分压(PETCO_2)差异有显著性差异(P<0.05);3组患儿CO_2消耗量、手术时间无显著性差异(P>0.05);在疼痛评估方面,低气腹压组、阶梯式气腹组患儿术后12h疼痛程度低于常规气腹压组患儿(P<0.05)。结论医护人员密切配合、适时动态调节气腹压力(阶梯式气腹压力)下实施腹腔镜疝囊高位结扎术是安全、可行的,并可显著降低患儿术后疼痛程度。
Objective To evaluate the effects of various pneumoperitoneum pressure on perioperative recovery in children underwent laparo- seopie high ligation of hernial sac. Methods Before laparoseopic high ligation of hernial sac, sixty children were randomly divided into 3 groups ：group A （ conventional pneumoperitoneum pressure, 9 mmHg） , group B （ low pneumoperitoneum pressure, 7 mmHg） and group C （ step - down pneumoperitoneum pressure,9 mmHg - 5 mmHg）. The vital signs and blood gas analysis of 3 groups were recorded and com- pared at 10 min before and 10 rain after the establishment of pneumoperitoneum as well as the end of operation. Moreover, the postoperative pain degree were evaluated and compared between 3 groups. Results All the operations in 3 groups were finished without converting to open, and all the children recovered smoothly without perioperative complications. Systolic and diastolic blood pressure and HCO3- detected at 10min after pneumoperitoneum was significantly elevated, and the systolic pressure and heart rate of the pressure were higher than before the estab- lishment of pneumoperitoneum which has statistics significance （ P 〈 0.05 ）. there were no significantly different of the CO2 consumption and operation time between the three groups （ P 〉 0.05 ）. However, the pain degree of low pneumoperitoneum pressure and step - down pneumo- peritoneum pressure 12h after operation were lower than those in the conventional pneumoperitoneum pressure（P 〈 0.05）. Statistical signifi- cances were found in the difference between 10 min after the establishment of pneumoperitoneum and the end of operation and the discrepancy of PaCO2 and ETCO2 in the above mentioned timing（ P 〈 0.05 ）. Conclusion It is safe and feasible that carrying out laparoscopic high liga- tion of hernial sac with a step - down pneumoperitoneum pressure,which may reduces the pain degree caused by the operation.
作者
赵海璇
谭淑芳
伍耀豪
李光霞
陈泓
李卫星
ZHAO Hai - xuan;TAN Shu -fang;WU Yao - hao;LI Guang - xia;Chen Hong;LI Wei - xing(Department of Operating Theater, Sun Yat - sen memorial Hospital of Sun Yat - sen University, 510120, Guangzhou China)
基金
中山大学孙逸仙纪念医院护理科研基金资助
关键词
气腹压
腹腔镜疝囊高位结扎
血气分析
Pneumoperitoneum pressure
Laparoscopic high ligation of hernial sac
Blood gas analysis
