腹腔镜肾盂输尿管成型术中CO2气腹对儿童机体酸碱平衡的影响

Effects of CO2 pneumoperitoneum in laparoscopic pyeloplasty on acid-base balance in children

摘要:

目的：探讨腹腔镜肾盂输尿管成型术中CO2气腹对儿童机体酸碱平衡的影响及其防治措施。方法：选择2010年1月至2011年6月在我科完成的经腹腔镜及开放式肾盂输尿管成型术各64例，分为腹腔镜组和开放组，并按年龄分为婴幼儿组、学龄前组和学龄组。选择2011年7月至2012年2月完成的腹腔镜肾盂输尿管成型术26例，术毕采取用空气充分置换腹腔残余CO2措施，作为腹腔镜空气置换组。所有病例均于术后4 h行动脉血气分析检测。结果：腹腔镜组术后高碳酸血症发生率为35.9%，高于开放组（18.7%）（?字2=4.578，P=0.029）。婴幼儿组、学龄前组酸碱失衡发生率分别为91.3%、84.2%（腹腔镜组）及84.4%、76.5%（开放组），均高于学龄组（50.0%、33.3%）（P<0.05）。腹腔镜空气置换组术后高碳酸血症发生率为11.5%，低于腹腔镜组（35.9%）（P<0.05）。结论：腹腔镜肾盂输尿管成型术中腹腔残余CO2是导致儿童术后高碳酸血症的重要因素。年龄越小，CO2气腹对机体酸碱平衡影响越大。术毕充分置换腹腔残余CO2是降低术后高碳酸血症发生率的重要措施。

Abstract:

Objective：To discuss the effects CO2 pneumoperitoneum on acid-base balance in children after laparoscopic pyeloplasty and its prevention measures. Methods：Totally 64 patients underwent laparoscopic pyeloplasty and 64 patients underwent open Ander－son-Hynes pyeloplasty from January 2010 to June 2011 were divided into laparoscopic group and open group. All patients were divid－ed into infants group，preschool-age group and school-age group respectively. Twenty-six patients underwent laparoscopic pyeloplasty from July 2011 to February 2012 were selected as laparoscopic air replacement group，in which peritoneal residual CO2 was sufficiently replaced with air at the end of operation. Blood gas analysis was made at 4 h after operation for all patients. Results：Hypercapnia incidence of laparoscopic group was 35.9%，higher than that of open group（18.7%）（?字2=4.578，P=0.029）. Incidences of acid-base imbalance in infants group and preschool-age group were 91.3%，84.2%（laparoscopic group） and 84.4%，76.5%（open group） respective－ly，higher than those in school-age group（50.0%，33.3%）（P<0.05）. Hypercapnia incidence of laparoscopic air replacement group was 11.5%，lower than that in laparoscopic group（35.9%）（P<0.05）. Conclusions：Peritoneal residual CO2 in laparoscopic pyeloplasty is the major influence factor that can cause postoperative hypercapnia in children. The younger the age，the greater the effect of CO2 pneu－moperitoneum on the acid-base balance. Sufficiently replacing peritoneal residual CO2 is the important measure that can decrease postoperative hypercapnia incidences.