低气腹压力腹腔镜手术对儿童局部肾氧饱和度的影响

摘要

目的 探讨腹腔镜手术低气腹压力对儿童局部肾氧饱和度(RrSO2)的影响.方法 选择2016年8月至2017年10月深圳市儿童医院择期行腹腔镜短小手术患儿80例为研究对象,按随机数表法分为低压组(1.33 kPa)和高压组(1.87 kPa),每组40例,观察两组患儿气腹前10 min (T0)、气腹中5 min (T1)、气腹中10 min (T2),停气腹后10 min (T3)的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO2)、脑氧饱和度(CrSO2)、RrSO2等指标的变化,同时监测T0~T3时点肾功能指标,如尿素氮(BUN)、肌酐(SCr)、血清β2-微球蛋白(β2-MG)等,Pearson相关分析HR、DBP、RrSO2、SpO2、CrSO2之间的相关性.结果 两组患儿HR、SBP、SpO2、CrSO2在T1、T2时点出现上升趋势, T3时点出现下降趋势,且两组患儿DBP、RrSO2在各时点比较差异均具有统计学意义(P<0.05);高气腹压组患儿RrSO2在T2时点明显低于低压组,差异具有统计学意义(P<0.05);低气压组和高气压组患儿BUN、SCr、β2-MG在T1、T2时点均出现上升(P<0.05),于T3时点处出现下降趋势,高压组BUN在T2时点明显高于低压组,差异具有统计学意义(P<0.05);RrSO2与CrSO2呈中度正相关(r=0.527,P<0.01),SpO2与RrSO2、CrSO2无相关性.结论 低二氧化碳气腹压力对患儿的肾氧饱和度和肾功能影响小,是腹腔镜气腹压力的最佳选择.%Objective To investigate the effect of low-pressure pneumoperitoneum (LP) in laparoscopic sur-gery on local renal oxygen saturation (RrSO2) in children. Methods A total of 80 patients scheduled for laparoscopic surgery from Aug. 2016 to Oct. 2017 in Shenzhen Children's Hospital were chosen, which were randomly divided into low-pressure group (1.33 kPa) and high-pressure group (1.87 kPa), with 40 patients in each group. Heart rate (HR), sys-tolic pressure (SBP), diastolic pressure (DBP), pulse oxygen saturation (SpO2), cerebral oxygensaturation (CrSO2), RrSO2and other indicators were observed 10 minutes before pneumoperitoneum (T0), 5 minutes during pneumoperitone-um (T1), 10 min (T2) during pneumoperitoneum, 10 minutes after pneumoperitoneum (T3). Renal function indexes of urea nitrogen (BUN), creatinine (SCr), β2-microglobulin (β2-MG) changes were monitored at T0-T3. Pearson correla-tion was used to analyze the correlation between HR, DBP, and RrSO2, SpO2, CrSO2. Results HR, SBP, SpO2, CrSO2of low-pressure group and high-pressure group increased at T1 and T2, and then decreased at T3, and the differences be-tween the two groups in DBP and RrSO2at each time point were statistically significant (P<0.05). RrSO2at T2 in high-pressure group was significantly lower than that of low-pressure group (P<0.05). BUN, SCr and β2-MG of the two groups were increased at T1, T2, decreased at T3, and BUN at T2 in high-pressure group was significantly higher than that of low-pressure group (P<0.05). A moderate positive correlation was found between RrSO2and CrSO2(r=0.527, P<0.01). There was no correlation between SpO2and RrSO2, CrSO2. Conclusion Low-pressure carbondioxide pneumo-peritoneum has little effect on renal oxygen saturation and renal function in children, and it is the best choice for laparo-scopic pneumoperitoneum.