达芬奇辅助腹腔镜下小儿肾盂输尿管成形术的麻醉管理

摘要

目的:总结达芬奇辅助腹腔镜下小儿肾盂输尿管成形术的麻醉经验,探讨达芬奇机器人在小儿泌尿外科手术中的优越性及麻醉管理的复杂性.方法:回顾性分析2015年12月~2016年3月接受达芬奇辅助腹腔镜肾盂输尿管成形术20例(男12例,女8例,平均年龄6.4岁)患儿的麻醉过程及临床资料,术中监测呼气末二氧化碳分压和动脉血气,术后进行疼痛评估并记录麻醉时间、手术时间及住院时间,并与前期开腹手术治疗的22例患儿手术及麻醉过程进行比较.结果:20例患儿麻醉时间为(190.3±24.6)min,手术时间为(162.7±12.5)min,较开腹麻醉和手术时间明显延长;达芬奇辅助腹腔镜手术时,动脉血二氧化碳分压和呼气末二氧化碳分压在气腹开始后即明显高于气腹前的基线水平(P<0.05),pH在气腹开始1 h后较气腹前明显降低(P<0.05);术中出血量(136.5±14.3)ml,术后疼痛评分(3.8±1.3),住院时间(5.6±1.0)d,均明显低于传统开腹手术.结论:达芬奇机器人手术在小儿泌尿外科治疗中具有创伤小、出血少、术野清晰、术后疼痛减轻等优点.但因气腹时间较长,较开腹手术相比,术中更易发生酸碱失衡,对麻醉管理要求更高.%Objective:To summarize the anesthesia experiences of laparoscopic pyeloureteroplasty with da Vinci robotic system in children and discuss its superiority in pediatric urologic surgery and the complexity of anesthesia management.Methods:Twenty patients who underwent robotic-assisted laparoscopic pyeloureteroplasty were enrolled in the study,their anesthesia process and clinical records were analyzed,including PETCO2,arterial blood gas analysis,anesthesia time,operation time,hospital stay and pain evaluation after operation,and compared to those of children who received open pyeloureteroplasty.Results:Twenty robotic-assisted operations have been performed in our hospital.The average age of the children was 6.4 years.The total of anesthesia time (190.3±24.6 min) and operation time (162.7±12.5 min) were longer than open laparotomy.The PaCO2 and PETCO2 were significantly elevated at the start of pneumoperitoneum as compared with those at the baseline before pneumoperitoneum (P<0.05).The pH value was significantly decreased 1 h after pneumoperitoneum as compared with that at the baseline before pneumoperitoneum (P<0.05).These situations were improved after ventilator adjustments.The blood loss,hospital stay and pain score were (136.5±14.3) mL,(5.6±1.0) days and (3.8±1.3) respectively.Conclusions:Robotic-assisted pediatric urologic surgery produced many advantages,such as less trauma,less blood loss,clearer operation field,shorter postoperative hospital stays and milder postoperative pain.But it is more likely to have acid-base imbalance compared with laparotomy,and puts forward higher requirements for anesthetic management.