【摘要】：目的 探討允許性高碳酸血癥(permissive hypercapnia,PHC)在胸腔鏡治療新生兒先天性食管閉鎖手術(shù)中的應(yīng)用效果。方法 選擇行胸腔鏡下先天性食管閉鎖(congenital esophageal atresia,CEA)I期吻合術(shù)的新生兒30例,男17例,女13例,出生1~5d,體重1.42~3.28kg,ASAⅡ或Ⅲ級。隨機分為PHC組(P組)和對照組(C組),每組15例。兩組新生兒均采用氣管內(nèi)插管靜-吸復(fù)合全麻,FiO2100%,新鮮氣流量2L/min。P組VT6ml/kg,C組VT_10ml/kg。根據(jù)氣道壓及血氣分析結(jié)果,通過調(diào)節(jié)呼吸機RR和PEEP參數(shù),維持P組PaCO_2為60~80mm Hg,C組PaCO_2為35~45mm Hg。記錄氣胸建立前(T0)、氣胸建立后15min(T_1)、30min(T_2)、60min(T3)和氣胸解除后15min(T4)的動脈血氣分析。記錄術(shù)后2h內(nèi)氣胸發(fā)生情況及術(shù)畢至撤離呼吸機時間。結(jié)果T_1時,P組P_(ET)CO_2明顯高于C組[(73.93±3.53)mm Hg vs.(41.53±1.59)mm Hg,P0.05],動脈血pH值明顯低于C組(7.25±0.02vs.7.38±0.03,P0.05),PaCO_2明顯高于C組[(74.80±2.45)mm Hg vs.(41.93±1.39)mm Hg,P0.05];T2時,P組P_(ET)CO_2明顯高于C組[(73.46±3.04)mm Hg vs.(41.30±1.29)mm Hg,P0.05],動脈血pH值明顯低于C組(7.24±0.01vs.7.37±0.03,P0.05),PaCO_2明顯高于C組[(75.33±2.19)mm Hg vs.(42.01±1.31)mm Hg,P0.05];T3時,P組P_(ET)CO_2明顯高于C組[(74.13±2.85)mm Hg vs.(41.67±1.35)mm Hg,P0.05],動脈血pH值明顯低于C組(7.25±0.01vs.7.38±0.02,P0.05),PaCO_2明顯高于C組[(75.20±2.08)mm Hg vs.(42.13±1.19)mm Hg,P0.05]。P組氣胸發(fā)生率明顯低于C組(6.7%vs.40.0%,P0.05)。P組與C組術(shù)畢至撤離呼吸機時間差異無統(tǒng)計學(xué)意義[(3.6±0.6)d vs.(3.5±0.6)d]。結(jié)論 允許性高碳酸血癥(PaCO_260~80mm Hg)可以安全應(yīng)用于胸腔鏡治療新生兒先天性食管閉鎖手術(shù),同時可以明顯降低氣胸的發(fā)生率。
[Abstract]:Objective to investigate the effect of allowable hypercapnia (permissive hypercapnia,PHC) in thoracoscopic treatment of neonatal congenital esophageal atresia. Methods 30 neonates with thoracoscopic congenital esophageal atresia (congenital esophageal atresia,CEA) stage I anastomosis were selected, including 17 males and 13 females, 1 鈮，

本文編號：2528910