Application of permissive hypercapnia in thoracoscopic surgery of neonates with congenital esophageal ;atresia
- VernacularTitle:允许性高碳酸血症在胸腔镜治疗新生儿先天性食管闭锁手术中的应用
- Author:
Weizhi ZHANG
;
Suli SHI
;
Gaihua LYU
- Keywords:
Permissive hypercapnia;
Thoracoscopic surgery;
Neonate;
Congenital esophageal atresia
- From:
The Journal of Clinical Anesthesiology
2017;33(2):117-120
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the application of permissive hypercapnia in the thoraco-scopic surgery of neonates with congenital esophageal atresia.Methods Thirty newborns with con-genital esophageal atresia,seventeen males,thirteen females,aged 1-5 days,weighing 1.42-3.28 kg, ASA physical status Ⅱ or Ⅲ,undergoing the thoracoscopic surgery,were randomly divided into group P and group C,n =1 5 in each group.The newborns were intratracheally intubated and adopted intravenous anesthesia combining inhalational anesthesia.FiO 2 100%,fresh gas flow 2 L/min,then adjusted the respirator parameters according to the results of airway pressure and arterial blood gas a-nalysis.Group P maintained PaCO 2 ranging at 60-80 mm Hg,group C maintained PaCO 2 ranging at 35-45 mm Hg.Arterial blood gas analysis was conducted respectively before artificial pneumothorax (T0 ),1 5 min after foundation of artificial pneumothorax (T1 ),30 min after foundation of artificial pneumothorax (T2 ),60 min after foundation of artificial pneumothorax (T3 )and 1 5 min after artifi-cial pneumothorax (T4 ).Two hours after surgery,a chest X ray photograph was taken to observe pneumothorax.The time from the end of the surgery to the ventilator weaning was recorded. Results At T1-T3 ,the PET CO 2 [(73.93 ± 3.53 )mm Hg vs.(41.53 ± 1.59 )mm Hg,(73.46 ± 3.04)mm Hg vs.(41.30±1.29)mm Hg,(74.13±2.85)mm Hg vs.(41.67 ±1.35)mm Hg]in group P were greatly higher than those in group C (P <0.05);the arterial blood pH value of group P (7.25±0.02 vs.7.38 ± 0.03,7.24 ± 0.01 vs.7.37 ± 0.03,7.25 ± 0.01 vs.7.38 ± 0.02 )were greatly lower than those in group C (P <0.05);PaCO 2 [(74.80±2.45)mm Hg vs.(41.93±1.39) mm Hg,(75.33±2.1 9)mm Hg vs.(42.01±1.31)mm Hg,(75.20±2.08)mm Hg vs.(42.13± 1.1 9)mm Hg ] were greatly higher than those in group C (P < 0.05 ).The incidence of pneumothorax of group P was obviously lower than that of group C (6.7% vs.40.0%,P <0.05 ). There was no statistically significant difference of the time from the end of surgery to the ventilator weaning [(3.6±0.6)d vs.(3.5 ±0.6)d]between the two groups.Conclusion Permissive hyper-capnia significantly reduces the incidence of pneumothorax in the thoracoscopic surgery of neonates with congenital esophageal atresia.Permissive hypercapnia (PaCO 2 60-80 mm Hg)can be safely ap-plied to the thoracoscopic surgery of neonates with congenital esophageal atresia.
