胸腔镜下微创漏斗胸矫正手术对患儿血流动力学及肺内分流的影响

Effect of nuss procedure by video-assisted thoracoscopy on hemodynamics and intrapulmonary shunt in children patients

摘要:

目的 观察微创漏斗胸矫正（Nuss）手术对患儿血流动力学及肺内分流的影响。方法 选择行Nuss手术患儿30例，年龄3～12岁，体质量9.5～26.8 kg，ASAⅠ～Ⅱ级，心肺功能基本正常，调节麻醉深度，使脑电双频指数（BIS）维持在35~45之间，分别于气胸前（T0）、气胸即刻（T1）、气胸后5 min（T2）、10 min（T3）、15 min（T4）、30 min（T5）及术毕（T6），抽取动脉血和混合静脉血，进行血气分析，计算肺内分流率（Qs/Qt），连续监测SBP、DBP、MBP、HR、CVP、呼气末二氧化碳（PETCO2）及SPO2。结果 与气胸前比较，SBP、DBP、MBP、HR、CVP及PETCO2显著上升，SPO2 及PO2明显下降，Qs/Qt无显著变化。结论 Nuss手术二氧化碳（CO2）人工气胸对患儿血流动力学影响较大，而对肺内分流无显著影响

Abstract:

【Objective】 To investigate effect of nuss procedure by video-assisted thoracoscopy on hemodynamics and intrapulmonary shunt in children. 【Methods】 Thirty children patients ASAⅠ~Ⅱwho aged from 3~12 years, weighted 9.5~26.8 kg and scheduled undergoing nuss procedure with normal cardiopulmonary function were observed. The depth of anesthesia was adjusted to maintain BIS at 35~45. The arterial blood and mixed venous blood was taken to blood gas analysis and accounting rate of intrapulmonary shunt before pneumothorax creation, in pneumothorax creation moment, at 5,10,15 and 30 minutes after pneumothorax creation. SBP, DBP, MBP, HR, CVP, PETCO2 and SPO2 changes were monitored consecutively. 【Results】 SBP, DBP, MBP, HR, CVP and PETCO2 were significantly higher in pneumothorax creation monently and after pneumothorax creation than those before pneumothorax creation, while SPO2 and PO2 significantly decreased and Qs/Qt had no significant change. 【Conclusion】 Nuss operation with CO2 artificial pneumothorax creation severely affect hemodynamics stabilization , while it has no influence on intrapulmonary shunt.