压力支持通气在七氟醚麻醉下小儿腹腔镜胆总管囊肿切除术围手术期中的应用价值

Application of pressure support ventilation in perioperative period of laparoscopic choledochal cystectomy under sevoflurane anesthesia in children

摘要:

目的 探讨压力支持通气（PSV）在七氟醚麻醉下小儿腹腔镜胆总管囊肿切除术围手术期中的应用价值。方法 选取2017年2月－2019年6月该院接受腹腔镜胆总管囊肿切除术的患儿54例，按随机数表法分为研究组（n = 27）和对照组（n = 27）。两组患儿均于七氟醚麻醉状态下接受腹腔镜胆总管囊肿切除术，术中研究组采取PSV，对照组采取压力控制通气（PCV）。统计两组患儿手术情况、不同时点血流动力学指标、围手术期不良事件和术后并发症发生情况。结果 两组患儿气腹时间、手术时间、动脉血氧分压（PaO₂）和动脉血二氧化碳分压（PaCO₂）比较，差异无统计学意义（P > 0.05），研究组气管导管拔除时间明显短于对照组，差异有统计学意义（P < 0.05）；两组患儿麻醉诱导前（T₁）～术毕即刻（T₅）组内心率（HR）及平均动脉压（MAP）比较，差异无统计学意义（F_HR = 0.68，P_HR = 0.410；F_MAP = 0.63，P_MAP = 0.427），两组间HR和MAP比较，差异无统计学意义（F_HR = 0.64，P_HR = 0.424；F_MAP = 0.11，P_MAP = 0.740）；在T₆时点，两组患者HR和MAP水平，差异有统计学意义（t_HR = 4.84，P_HR = 0.028；t_MAP = 4.69，P_MAP = 0.030）；研究组围手术期不良事件发生率为7.41%，明显低于对照组的29.63%，两组患儿比较，差异有统计学意义（P < 0.05）；研究组术后并发症发生率为3.70%，与对照组的11.11%比较，差异无统计学意义（P > 0.05）。结论 在七氟醚麻醉状态下，于小儿腹腔镜胆总管囊肿切除术中采取PSV，可缩短气管导管拔除时间，减少拔管时血压及HR的波动幅度，降低围手术期不良事件发生率，保证了治疗的安全性。值得临床推广应用。

Abstract:

Objective To explore the application value of pressure support ventilation (PSV) in perioperative period of laparoscopic choledochocystectomy in children under sevoflurane anesthesia.Method 54 children who underwent laparoscopic choledochal cyst resection from February 2017 to June 2019 were selected and divided into study group (n = 27) and control group (n = 27) according to the random number table. The two groups of children underwent laparoscopic choledochal cyst resection under sevoflurane anesthesia. PSV was used in the study group and pressure controlled ventilation (PCV) was used in the control group. The operation conditions, hemodynamic indexes at different time points, perioperative adverse events and postoperative complications of the two groups were analyzed.Results There was no significant difference in pneumoperitoneum time, operation time, arterial oxygen partial pressure (PaO₂) and arterial carbon dioxide partial pressure (PaCO₂) between the two groups (P > 0.05). The time of tracheal tube extubation in the study group was significantly shorter than that in the control group (P < 0.05); There was no significant difference in heart rate (HR) and mean arterial pressure (map) between the two groups (F_HR = 0.68, P_HR = 0.410; F_MAP = 0.63, P_MAP = 0.427) before anesthesia induction (T₁) and immediately after operation (T₅). There was no significant difference in HR and MAP between the two groups (F_HR = 0.64, P_HR = 0.424; F_MAP = 0.11, P_MAP = 0.740); At time point T₆, there were significant differences in HR and MAP levels between the two groups (t_HR = 4.84, P_HR = 0.028; t_MAP = 4.69, P_MAP = 0.030); The incidence of perioperative adverse events in the study group was 7.41%, which was significantly lower than that in the control group (29.63%). The difference between the two groups was statistically significant (P < 0.05); The incidence of postoperative complications in the study group was 3.70%, which was not significantly different from 11.11% in the control group (P > 0.05).Conclusion PSV can shorten the extubation time of air tube catheter, reduce the fluctuation of blood pressure and HR during extubation and the adverse events during perioperative period, and ensure the safety of treatment. It is worthy of clinical promotion.