二氧化碳气腹对不同年龄组小儿脑氧饱和度和术后躁动的影响

Impact of carbon dioxide pneumoperitoneum on regional cerebral oxygenation and emergence delirium in children of different ages

摘要:

目的 通过观察二氧化碳气腹对不同年龄组小儿脑氧饱和度和术后躁动的影响，探讨小儿脑氧饱和度监测的临床意义。方法 择期行腹腔镜下疝囊高位结扎术患儿90例，ASAⅠ级，按年龄分为3组：1～3岁 为S组（30例）；>3～6岁为M组（30例）；>6～14岁为L组（30例）。采用全凭静脉麻醉，机械通气维持呼 气末二氧化碳分压（PETCO2）在35～45?mmHg。分别于麻醉诱导后（T0）、气腹即刻（T1）、气腹后5?min（T2）、 10?min（T3）、气腹结束（T4）、术后5?min（T5）记录患儿心率（HR）、收缩压（SBP）、血氧饱和度（SpO2）、PETCO2、左脑氧饱和度和右脑氧饱和度；计算脑氧饱和度下降最大幅度%ΔrSO2MAX；记录手术时间、麻醉时间、苏醒时间及苏醒即刻的躁动评分。结果 不同时间点脑氧饱和度比较有差异（P?<0.05），与T0、T1、T4、T5比较，S组患者在T2、T3时间点左脑氧饱和度和右脑氧饱和度下降（P?<0.05）；M、L组各时间点脑氧饱和度比较无差异（P?>0.05）。3组左脑氧饱和度和右脑氧饱和度比较无差异（P?>0.05）。与M、L组比较，S组 的躁动评分升高（P?<0.05）；%ΔrSO2MAX、躁动评分与年龄有相关性（P?<0.05），且S组中%ΔrSO2MAX与年龄呈负相关（P?<0.05），躁动评分与%ΔrSO2MAX无相关性（P?>0.05）。结论 二氧化碳气腹对1～3岁患儿具有潜在脑氧饱和度下降风险，且年龄越小影响越大；苏醒期躁动与脑氧饱和度的下降无相关性。

Abstract:

Objective To explore the significance of monitoring cerebral oxygen saturation in children through observing the effect of carbon dioxide pneumoperitoneum on cerebral oxygen saturation and emergence delirium in children of different ages. Methods A total of 90 patients, ASA physical status I, undergoing laparoscopic operation for inguinal hernia repair were included. Children were scheduled by age: group S (n?=?30) aged from 1 to 3; group M (n?=?30) from > 3 to 6 years old; group L (n?=?30) from > 6 to 14 years old. The method of anesthesia is total intravenous anesthesia. Patients underwent mechanical ventilation adjusted to achieving an end-tidal CO2 level of 35 to 45 mmHg. HR, SBP, SpO2, PETCO2, LrSO2 and RrSO2 were collected after induction of anesthesia (baseline, T0) and at pneumoperitoneum immediately (T1), 5 mins after pneumoperitoneum (T2), 10 mins after pneumoperitoneum (T3), cessation of pneumoperitoneum (T4), 5 mins after operation (T5). The maximum change in cerebral oxygen saturation and %ΔrSO2MAX were calculated. The times for operation, anesthesia, awaken and the agitation scores were recorded. Results There were differences in brain oxygen saturation among three groups at different time points (P 0.05); there was no significant difference in cerebral oxygen saturation between the three groups at each time (P?> 0.05); compared with groups M and L, the agitation score of group S was significantly increased and the difference was statistically significant (P??0.05). Conclusion Carbon dioxide pneumoperitoneum in children aged from 1 to 3 has a potential risk of decreased cerebral oxygen saturation, and the younger the age, the greater the effect. Emergence delirium is not associated with decreased cerebral oxygen saturation.