【摘要】 目的探讨允许性高碳酸血症（permissive hypercapnia,PHC）在胸腔镜治疗新生儿先天性食管闭锁手术中的应用效果。方法选择行胸腔镜下先天性食管闭锁（congenital esophageal atresia,CEA）I期吻合术的新生儿30例,男17例,女13例,出生1⁵d,体重1.42³.28kg,ASAⅡ或Ⅲ级。随机分为PHC组（P组）和对照组（C组）,每组15例。两组新生儿均采用气管内插管静-吸复合全麻,FiO2100%,新鲜气流量2L/min。P组VT6ml/kg,C组VT₁0ml/kg。根据气道压及血气分析结果,通过调节呼吸机RR和PEEP参数,维持P组PaCO₂为60⁸0mm Hg,C组PaCO₂为35⁴5mm Hg。记录气胸建立前（T0）、气胸建立后15min（T₁）、30min（T₂）、60min（T3）和气胸解除后15min（T4）的动脉血气分析。记录术后2h内气胸发生情况及术毕至撤离呼吸机时间。结果T₁时,P组P_ETCO₂明显高于C组[（73.93±3.53）mm Hg vs.（41.53±1.59）mm Hg,P<0.05],动脉血pH值明显低于C组（7.25±0.02vs.7.38±0.03,P<0.05）,PaCO₂明显高于C组[（74.80±2.45）mm Hg vs.（41.93±1.39）mm Hg,P<0.05];T2时,P组P_ETCO₂明显高于C组[（73.46±3.04）mm Hg vs.（41.30±1.29）mm Hg,P<0.05],动脉血pH值明显低于C组（7.24±0.01vs.7.37±0.03,P<0.05）,PaCO₂明显高于C组[（75.33±2.19）mm Hg vs.（42.01±1.31）mm Hg,P<0.05];T3时,P组P_ETCO₂明显高于C组[（74.13±2.85）mm Hg vs.（41.67±1.35）mm Hg,P<0.05],动脉血pH值明显低于C组（7.25±0.01vs.7.38±0.02,P<0.05）,PaCO₂明显高于C组[（75.20±2.08）mm Hg vs.（42.13±1.19）mm Hg,P<0.05]。P组气胸发生率明显低于C组（6.7%vs.40.0%,P<0.05）。P组与C组术毕至撤离呼吸机时间差异无统计学意义[（3.6±0.6）d vs.（3.5±0.6）d]。结论允许性高碳酸血症（PaCO₂60⁸0mm Hg）可以安全应用于胸腔镜治疗新生儿先天性食管闭锁手术,同时可以明显降低气胸的发生率。更多还原

【Abstract】 Objective To investigate the application of permissive hypercapnia in the thoracoscopic surgery of neonates with congenital esophageal atresia.Methods Thirty newborns with congenital esophageal atresia,seventeen males,thirteen females,aged 1-5days,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=15in each group.The newborns were intratracheally intubated and adopted intravenous anesthesia combining inhalational anesthesia.FiO₂ 100%,fresh gas flow 2L/min,then adjusted the respirator parameters according to the results of airway pressure and arterial blood gas analysis.Group P maintained PaCO₂ ranging at 60-80 mm Hg,group C maintained PaCO₂ ranging at 35-45 mm Hg.Arterial blood gas analysis was conducted respectively before artificial pneumothorax（T₀）,15 min after foundation of artificial pneumothorax（T₁）,30 min after foundation of artificial pneumothorax（T₂）,60 min after foundation of artificial pneumothorax（T₃）and 15 min after artificial 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 P_ETCO₂ [（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）;PaCO₂[（74.80±2.45）mm Hg vs.（41.93±1.39）mm Hg,（75.33±2.19）mm Hg vs.（42.01±1.31）mm Hg,（75.20±2.08）mm Hg vs.（42.13±1.19）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 hypercapnia significantly reduces the incidence of pneumothorax in the thoracoscopic surgery of neonates with congenital esophageal atresia.Permissive hypercapnia（PaCO₂ 60-80 mm Hg）can be safely applied to the thoracoscopic surgery of neonates with congenital esophageal atresia.更多还原