2020 年第 9 期 第 15 卷

新生儿胸腔镜手术中高碳酸血症对脑组织氧饱和度的影响

Effect of hypercapnia during neonatal thoracoscopy on regional cerebral oxygen saturation

作者：雷东旭范艳婷陈柳妹王怀贞张文华潘永英宋兴荣

英文作者：Lei Dongxu Fan Yanting Chen Liumei Wang Huaizhen Zhang Wenhua Pan Yongying Song Xingrong 

单位：广州市妇女儿童医疗中心麻醉科510623

英文单位：Department of Anesthesiology Guangzhou Women and Children′s Medical Center Guangzhou 510623 China

关键词：高碳酸血症；脑氧饱和度；新生儿；胸腔镜 

英文关键词：Hypercapnia;Cerebraloxygensaturation;Neonate;Thoracoscopy

• 摘要：

• 目的 探讨新生儿胸腔镜手术中高碳酸血症对脑组织氧代谢产生的影响。方法 选取2017年1月至2018年3月在广州市妇女儿童医疗中心行胸腔镜手术或腹腔镜手术的新生儿98例，根据手术方式分为胸腔镜组（48组）和腹腔镜组（50组）。比较2组患儿术前（T0）、麻醉诱导后（T1）、建立二氧化碳气胸/气腹后15 min（T2）、30 min（T3）、60 min（T4）和撤气胸/气腹后30 min（T5）、120 min（T6）的局部脑氧饱和度（rcSO2）、脉搏血氧饱和度（SpO2）、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、pH值和动脉血乳酸值。记录患儿术中rcSO2低于55%的情况。记录胸腔镜术中建立气胸使用的二氧化碳充气压力。结果 T2、T3、T4时胸腔镜组rcSO2明显低于腹腔镜组［（80±2）%比（81±2）%、（79±2）%比（80±2）%、（80±3）%比（81±2）%］，差异均有统计学意义（均P＜0.05）。2组患儿术中rcSO2均未低于55%。T0、T2、T3、T4、T5时胸腔镜组PaCO2明显高于腹腔镜组［（39±3）mmHg（1 mmHg=0.133 kPa）比（35±2）mmHg、（48±4）mmHg比（34±2）mmHg、（56±7）mmHg比（41±2）mmHg、（65±10）mmHg比（42±2）mmHg、（42±3）mmHg比（34±2）mmHg］，pH值明显低于腹腔镜组，差异均有统计学意义（均P＜0.01）。T2、T3时，胸腔镜组PaO2和SpO2明显低于腹腔镜组（均P＜0.01）。2组患儿各时点动脉血乳酸水平差异均无统计学意义（均P＞0.05）。本研究中建立气胸使用的二氧化碳充气压力为4～8 mmHg，不同压力组之间的rcSO2和PaCO2差异均无统计学意义（均P＞0.05）。结论 新生儿在胸腔镜手术中会出现严重的高碳酸血症，但不会造成rcSO2的异常。使用4～8 mmHg的二氧化碳充气压力建立气胸，对新生儿rcSO2没有影响。

• Objective To observe the effect of hypercapnia occurred during thoracoscopy on regional cerebral oxygen metabolism of neonates. Methods From January 2017 to May 2018, 98 neonates undergoing thoracoscopic surgery（48 cases） or laparoscopic surgery（50 cases） were enrolled at Guangzhou Women and Children′s Medical Center. Regional cerebral oxygen saturation(rcSO2), oxygen saturation of blood（SpO2）, arterial partial pressure of carbon dioxide(PaCO2), arterial partial pressure of oxygen(PaO2), pH value and arterial blood lactic acid level were recorded at following time points: before operation(T0), after anesthesia induction(T1), 15 min(T2), 30 min(T3) and 60 min(T4) after carbon dioxide insufflation, 30 min（T5）and 120 min(T6) after carbon dioxide exsufflation. Duration of rcSO2 below 55% and pressure of carbon dioxide insufflation were recorded. Results RcSO2 with thoracoscopy was lower than with laparoscopy at T2, T3, T4［（80±2）% vs （81±2）%,（79±2）% vs （80±2）%,（80±3）% vs （81±2）%］(all P＜0.05). RcSO2 never dropped below 55% in all neonates. PaCO2 with thoracoscopy was higher and pH was lower than with laparoscopy at T0, T2, T3, T4, T5［（39±3）mmHg vs （35±2）mmHg,（48±4）mmHg vs （34±2）mmHg, （56±7）mmHg vs （41±2）mmHg, （65±10）mmHg vs （42±2）mmHg, （42±3）mmHg vs （34±2）mmHg］（all P＜0.01）. PaO2 and SpO2 with thoracoscopy were lower than with laparoscopy at T2 and T3（all P＜0.01）. There was no significant difference in arterial blood lactic acid level between thoracoscopy and laparoscopy（P＞0.05）. Carbon dioxide insufflation pressure of 4-8 mmHg was used in the study, and no difference was noticed in rcSO2 and PaCO2 between neonates with different insufflation pressures（P＞0.05）. Conclusions Neonatal thoracoscopy using carbon dioxide pneumothorax leads to severe hypercapnia but rcSO2 remains within the range of clinical safety. Carbon dioxide insufflation pressure of 4-8 mmHg is acceptable in neonatal thoracoscopy.