A Clinical Study Of Peritoneal Laparoscopic Ventilation For Permissive Hypercapnia In Children

Objective:To investigate the effect of permissive hypercapnia on intraoperativ-e cerebral oxygen saturation,airway pressure,blood gas and postoperative adverse reactions in children undergoing laparoscopic surgery,and to evaluate the safety of permissive hypercapnia in children undergoing laparoscopic surgery.Methods:A total of 60 patients would be undergoing laparoscopic surgery we-re be chosen.They were ASA classⅡ,1⁴ years old,within the scope of normal weight,and the surgery time was estimated about 3⁵ h.Children were randomly divided into routine ventilation group（R group）and permissive hypercapnia venti-lation group（P group）,with 30 patients in each group.Intraoperative arterial blood gas results were used as a reference index to regulate the respiratory pressure,und-er the condition of maintaining non-pneumoperitoneum,PaCO₂ in both groups was35⁴5 mmHg,under pneumoperitoneum,PaCO₂ in group R was 35⁴5 mmHg,and that in group P was 45⁵5mmHg.Heart rate（HR）,systolic blood pressure（S BP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,pulse oxygen-saturation（SpO₂）,cerebral oxygen saturation（rSO₂）and body temperature were r-ecorded at 4 moments:before anesthesia（T0）,before pneumoperitoneum（T1）,pne-umoperitoneum 30 mins（T2）and postoperative（T3）.Arterial blood gas was taken at T1,T2 and T3 and airway platform pressure was recorded.Postoperative agitati-on was evaluated by the same nurse according to the PAED scale within 10min aft-er extubation in the recovery room.The occurrence of nausea and vomiting within24h was recorded.Results:（1）There was no statistically significant difference in general data such as demographics between the two groups（p>0.05）.（2）There were no significant differences in intraoperative operative time,pneumoperitoneum time,pneumoperi-toneum pressure,blood loss,urine volume,crystal and colloid volume between the two groups（p>0.05）.（3）HR,SBP,DBP,MAP,SpO₂ and body temperature of T0^T3 patients in the two groups showed no statistically significant difference（p>0.05）.There was no statistically significant difference in airway pressure between th-e two groups at T1 and T3（p>0.05）,while there was statistically significant diff-erence in airway pressure between the two groups at T2（p<0.05）.（4）There were no significant differences in pH,Hct,PaO₂,PaCO₂,HCO₃^-and Hb between the tw-o groups at T1 and T3（p>0.05）.There were statistically significant differences in pH,PaCO₂ and HCO₃^-between the two groups at T2（p<0.05）,but no statistically significant differences in Hct and Hb（p>0.05）.（5）Olny at T2,there was statistica-lly significant difference in rSO₂ between the two groups（p<0.05）;at T1^T3,t-he re was statistically significant difference in rSO₂ between the two groups（p<0.05）.（6）There was no significant difference in the incidence of postoperative emergenc-e agitation,nausea and vomiting between the two groups（p>0.05）.Conclusion:In laparoscopic surgery in children,permissive hypercapnia ventil-ation can play a role in protecting the lung and improving cerebral oxygen saturati-on without causing hypoxia and increasing the incidence of postoperative adverse reactions,which is a safe and feasible ventilation strategy.