Analysis the effect of pediatric laparoscopic hernia surgery on the blood gas index and circulating parameters

doi:10.3877/cma.j.issn.1674-392X.2018.02.004

Abstract

Abstract:

Objective

To explore the effect of pediatric laparoscopic hernia surgery on the blood gas index and circulating parameters.

Methods

74 cases chlidren with hernia in Zhangjiakou Maternity and Child Care from March 2015 to April 2016 were selected and all children were treated with pediatric laparoscopic hernia surgery. All child patients were divided into low pneumoperitoneum pressure group and high pneumoperitoneum pressure group according to the different of pneumoperitoneum pressure during operation, and 37 cases for each group. Intraoperative pneumoperitoneum pressure in low pneumoperitoneum pressure group maintained at 8 mmHg, and high pneumoperitoneum pressure group maintained at 12 mmHg. Detected and compared the blood gas index and circulating parameters preoperative, 10 min, 30 min after pneumoperitoneum and 10 min after deflated.

Results

The pneumoperitoneum time, pneumoperitoneum formation time and gas released time had no significant difference (P>0.05). Compared with pre-operation, the Paw, PetCO₂, PaCO₂ and CVP, SBP, DBP, MAP, HR, CO and SVR showed first increasing then decreasing trend. At 10 min and 30 min after pneumoperitoneum, those indicators were significantly higher in both two groups, and high pneumoperitoneum pressure group was higher than low pneumoperitoneum pressure group (P<0.01). The Paw, CVP and HR of 2 groups return to the preoperation level gradually at 10 min after deflated, and there was no significant difference between 2 groups (P>0.05). While the PetCO₂ and PaCO₂ at 10 min after deflated were higher than those in preoperation, and above indicators in high pneumoperitoneum pressure group were higher than those in low pneumoperitoneum pressure group (P<0.01). At the same time, the SBP, DBP, MAP, CO and SVR in high pneumoperitoneum pressure group were higher than preoperation level and SBP, DBP and CO were higher than those in low pneumoperitoneum pressure group. Compared with preoperation, the Cmp1 of 2 groups decreased significantly at 10 min and 30 min after pneumoperitoneum, and high pneumoperitoneum pressure group was higher than low pneumoperitoneum pressure group; the PaO₂ and SaO₂ had no significant changes (P>0.05); compared with preoperation, the ABE and SBE of low pneumoperitoneum pressure group had no significant changes (P>0.05), while the ABE and SBE of high pneumoperitoneum pressure group at 30 min after pneumoperitoneum increased significantly (P<0.05). The SV of 2 groups from pneumoperitoneum to 10 min after deflated had no significant changes (P>0.05).

Conclusion

High pneumoperitoneum pressure had a great influence on the blood gas index and circulating parameters in pediatric laparoscopic hernia surgery, so we should avoid >12 mmHg pneumoperitoneum in clinic.

Key words: Hernia, inguinal, Herniorrhaphy, Laparoscopes, Blood gas analysis, Circulation

Yonggang Liu. Analysis the effect of pediatric laparoscopic hernia surgery on the blood gas index and circulating parameters[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(02): 94-98.

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Figures/Tables 3

References 15

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组别	例数	气腹时间(min)	气腹形成时间(s)	放气时间(s)
低气腹组	37	35.3±4.3	10.6±3.3	5.4±1.6
高气腹组	37	35.6±4.6	11.2±3.5	5.8±1.5
t值	?	0.290	0.759	1.109
P值	?	0.773	0.451	0.271

组别	例数	气腹时间(min)	气腹形成时间(s)	放气时间(s)
低气腹组	37	35.3±4.3	10.6±3.3	5.4±1.6
高气腹组	37	35.6±4.6	11.2±3.5	5.8±1.5
t值	?	0.290	0.759	1.109
P值	?	0.773	0.451	0.271

组别	例数	指标	术前	气腹后10 min	气腹后30 min	放气后10 min
低气腹组	37	Paw	1.66±0.15	2.31±0.15^b	2.33±0.19^b	1.73±0.16
高气腹组	37	(kPa)	1.69±0.16	3.07±0.18^bd	3.16±0.21^bd	1.77±0.17
低气腹组	37	Cmpl	38.32±6.03	25.92±4.01^a	25.83±4.11^a	35.86±5.53
高气腹组	37	(ml/mbar)	38.44±6.02	22.66±3.92^ad	22.80±3.73^ad	37.97±5.02
低气腹组	37	PetCO₂	4.24±0.34	5.06±0.36^b	5.75±0.37^b	4.29±0.34
高气腹组	37	(kPa)	4.23±0.33	5.73±0.39^bd	6.03±0.39^bd	4.58±0.38^bd
低气腹组	37	PaCO₂	4.34±0.36	5.23±0.34^b	6.11±0.37^b	4.42±0.39
高气腹组	37	(mmHg)	4.33±0.35	5.86±0.39^bd	6.43±0.38^bd	4.75±0.41^bd
低气腹组	37	PaO₂	14.31±0.51	14.76±0.52	14.33±0.52	14.41±0.50
高气腹组	37	(mmHg)	14.42±0.53	14.31±0.51	14.37±0.52	14.58±0.52
低气腹组	37	SaO₂	99.53±0.41	98.96±0.37	99.06±0.40	99.56±0.43
高气腹组	37	(%)	99.62±0.39	98.85±0.36	98.31±0.37	99.60±0.50
低气腹组	37	ABE	2.14±-0.63	2.21±-0.65	2.30±-0.66	2.22±-0.65
高气腹组	37	(mmol/L)	2.09±-0.65	2.41±-0.64	2.55±-0.63^b	2.32±-0.59
低气腹组	37	SBE	2.13±-0.66	2.29±-0.64	2.31±-0.68	2.23±-0.65
高气腹组	37	(mmol/L)	2.11±-0.67	2.42±-0.65	2.52±-0.67^a	2.31±-0.61

组别	例数	指标	术前	气腹后10 min	气腹后30 min	放气后10 min
低气腹组	37	Paw	1.66±0.15	2.31±0.15^b	2.33±0.19^b	1.73±0.16
高气腹组	37	(kPa)	1.69±0.16	3.07±0.18^bd	3.16±0.21^bd	1.77±0.17
低气腹组	37	Cmpl	38.32±6.03	25.92±4.01^a	25.83±4.11^a	35.86±5.53
高气腹组	37	(ml/mbar)	38.44±6.02	22.66±3.92^ad	22.80±3.73^ad	37.97±5.02
低气腹组	37	PetCO₂	4.24±0.34	5.06±0.36^b	5.75±0.37^b	4.29±0.34
高气腹组	37	(kPa)	4.23±0.33	5.73±0.39^bd	6.03±0.39^bd	4.58±0.38^bd
低气腹组	37	PaCO₂	4.34±0.36	5.23±0.34^b	6.11±0.37^b	4.42±0.39
高气腹组	37	(mmHg)	4.33±0.35	5.86±0.39^bd	6.43±0.38^bd	4.75±0.41^bd
低气腹组	37	PaO₂	14.31±0.51	14.76±0.52	14.33±0.52	14.41±0.50
高气腹组	37	(mmHg)	14.42±0.53	14.31±0.51	14.37±0.52	14.58±0.52
低气腹组	37	SaO₂	99.53±0.41	98.96±0.37	99.06±0.40	99.56±0.43
高气腹组	37	(%)	99.62±0.39	98.85±0.36	98.31±0.37	99.60±0.50
低气腹组	37	ABE	2.14±-0.63	2.21±-0.65	2.30±-0.66	2.22±-0.65
高气腹组	37	(mmol/L)	2.09±-0.65	2.41±-0.64	2.55±-0.63^b	2.32±-0.59
低气腹组	37	SBE	2.13±-0.66	2.29±-0.64	2.31±-0.68	2.23±-0.65
高气腹组	37	(mmol/L)	2.11±-0.67	2.42±-0.65	2.52±-0.67^a	2.31±-0.61

组别	例数	指标	术前	气腹后10 min	气腹后30 min	放气后10 min
低气腹组	37	CVP	1.5±0.4	2.2±0.7^b	1.7±0.3^a	1.4±0.5
高气腹组	37	(kPa)	1.5±0.5	2.5±0.5^bc	1.9±0.4^bc	1.5±0.5
低气腹组	37	SBP	17.4±1.4	19.7±1.2^b	18.9±1.7^b	17.6±1.9
高气腹组	37	(kPa)	17.5±1.2	20.9±1.5^bd	19.9±1.8^bc	19.2±1.7^bc
低气腹组	37	DBP	9.8±1.5	14.8±1.6^b	13.3±1.7^b	11.2±1.3
高气腹组	37	(kPa)	9.6±1.6	15.9±1.7^bd	14.9±1.6^bd	13.3±1.2^bd
低气腹组	37	MAP	10.7±1.6	12.3±1.6^b	11.9±1.4^b	11.0±1.5
高气腹组	37	(kPa)	10.6±1.7	13.5±1.5^bd	13.0±1.5^bd	11.6±1.4^b
低气腹组	37	HR	69.0±10.1	86.6±10.9^b	84.4±11.1^b	70.2±11.1
高气腹组	37	(次/min)	68.9±10.2	91.7±11.0^bc	90.3±10.9^bc	71.4±12.3
低气腹组	37	CO	3.5±0.6	4.5±0.5^b	4.3±0.5^b	3.6±0.7
高气腹组	37	(L/min)	3.4±0.7	5.2±0.6^bd	5.0±0.6^bd	4.0±0.6^bc
低气腹组	37	SV	51.5±11.4	52.7±10.8	52.3±10.9	52.6±11.1
高气腹组	37	(ml/beat)	51.6±11.7	51.8±10.9	51.9±11.2	52.5±11.2
低气腹组	37	SVR	1448±567.5	2057±461.2^b	1756±421.5^b	1642±448.6
高气腹组	37	(dyne·s/cm⁵)	1481±560.3	2369±473.6^bd	1897±430.1^bc	1763±451.0^a

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