Study On The Effect Of Different CO₂ Pneumoperitoneum Pressure On Respiration And Circulation And The Optimal Pneumoperitoneum Pressure In Infants Undergoing Laparoscopic Surgery

Objective:In order to further explore the effects of different CO₂ pneumoperitoneum pressures in the lower level range??10mmHg?on the cardiac and pulmonary functions and their pathology-physiological mechanism in infants from 1 to 12months old,providing a reference for the selection of appropriate pneumoperitoneum pressure to minimize the influence of pneumoperitoneum on the respiratory and circulatory functions of infants.Methods:Randomly selected 60 cases of babies less than 1 year old who required laparoscopic surgery from May 2018 to March 2019,and were randomly divided into three groups according to the difference in the level of carbon dioxide pneumoperitoneum control during the operation,with 20 cases in each group.The carbon dioxide pneumoperitoneum pressure in group A was 6 mmHg;the carbon dioxide pneumoperitoneum pressure in group B was 8 mm Hg;and the carbon dioxide pneumoperitoneum pressure in group C was 10 mmHg.The anesthesiologists preoperatively evaluated the ASA to be grade?-?,and checked chest radiographs and color Doppler ultrasound before operation to rule out heart and lung diseases.All children were given general anesthesia for endotracheal intubation,and the ventilator was used to mechanically control the child's breathing in a fixed volume mode.The tidal volume was calculated by body weight,ie 10ml/kg,and the respiratory rate was controlled at 27 times/min.Select the supine position for the operation position,and monitor the heart rate?HR?and mean arterial pressure of the child 5 minutes before the establishment of the pneumoperitoneum after successful anesthesia?T0?,10 minutes after the establishment of the pneumoperitoneum?T1?,and 10 minutes after the release of pneumoperitoneum before recovery?T2??MBP?,airway resistance?Raw?,end-expiratory carbon dioxide partial pressure(P_ETT CO2),blood oxygen saturation?SpO2?.Because the establishment of carbon dioxide pneumoperitoneum can lead to blood gas changes and indirectly affect cardiopulmonary function,this study also collected blood gas analysis of the arterial blood at the radial artery at the corresponding time point to monitor PH and arterial blood carbon dioxide partial pressure?PaCO₂?.Results:?1?After the establishment of carbon dioxide pneumoperitoneum,the children's heart rate increased,mean arterial pressure increased,arterial blood carbon dioxide partial pressure and end-expiratory carbon dioxide partial pressure increased,airway resistance increased,and blood PH value decreased.And the higher the level of carbon dioxide pneumoperitoneum control,the greater the change of the above indicators.?2?When the carbon dioxide pneumoperitoneum pressure increases from 8mm Hg to 10mm Hg,the above-mentioned indicators change more than the pneumoperitoneum pressure increases from 6mmHg to 8mmHg.?3?Increasing the pneumoperitoneum pressure within the range of?10mmHg has little effect on the level of arterial oxygen saturation.Conclusion:In infants undergoing laparoscopic surgery,the establishment and maintenance of carbon dioxide pneumoperitoneum have a significant impact on breathing and circulation.In order to reduce the above effects and reduce intraoperative risks,the carbon dioxide pneumoperitoneum pressure should be controlled at?6-8?mmHg,shorten the duration of pneumoperitoneum to reduce the impact on breathing and circulation,and reduce surgical complications.