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目的探讨低压力气腹对先天性心脏病(CHD)患儿短小腹腔镜手术后心功能的影响。方法选取88例伴CHD的小儿腹股沟斜疝患儿为研究对象,均予以腹腔镜斜疝修补疗法。采用随机数字表法将其分成低压力气腹组(A组,n=44)和常规气腹组(B组,n=44)。对比两组患儿气腹前(T0)、气腹后10 min(T1)、消除气腹后10 min(T2)血流动力学指标及心脏超声指标变化情况。结果 1T1时,两组患者心率(HR)、平均动脉压(MAP)等血流动力学指标均较T0时明显提升(P<0.05),且B组各指标变化幅度均大于A组(P<0.05);T3时,两组患者各血流动力学指标比较差异未见统计学意义(P>0.05)。2A组患儿T0~T3时段内左室射血分数(LVEF),二尖瓣舒张早、晚期峰值速率比值(E/A),短轴缩短率(FS),心肌工作指数(Tei值)等超声心动图指标比较差异未见统计学意义(P>0.05);T1时,B组患儿LVEF及E/A检测结果均较T0时显著降低(P<0.05),FS及Tei值则较T0时无明显改变(P>0.05)。结论在低压力气腹下对伴CHD的腹股沟斜疝患儿予以腹腔镜斜疝修补术,对其心功能不良影响轻微,于患儿预后提升有利,值得临床推广。
Objective To investigate the effect of low pressure pneumoperitoneum on heart function after short laparoscopic surgery in children with congenital heart disease (CHD). Methods 88 children with inguinal hernia with CHD were enrolled in this study, all of whom were treated by laparoscopic oblique hernia repair. The patients were divided into two groups: low pressure pneumoperitoneum (group A, n = 44) and conventional pneumoperitoneum (group B, n = 44). The changes of hemodynamics and echocardiographic parameters were compared between the two groups before and after pneumoperitoneum (T0), pneumoperitoneum 10 min (T1) and pneumoperitoneum 10 min (T2). Results At 1T1, the hemodynamic indexes such as heart rate (HR) and mean arterial pressure (MAP) in both groups were significantly higher than those at T0 (P <0.05), and the changes in each index in group B were greater than those in group A (P < 0.05). At T3, there was no significant difference between the two groups in the hemodynamic parameters (P> 0.05). The left ventricular ejection fraction (LVEF), mitral early-diastolic and late peak velocity ratio (E / A), short axis shortening (FS) and myocardial work index (Tei) Compared with T0, the results of LVEF and E / A in B group were significantly lower (P <0.05) and the values of FS and Tei were higher than T0 No significant change (P> 0.05). Conclusions Under low pressure pneumoperitoneum, laparoscopic oblique hernia repair is performed in children with inguinal hernia with CHD, which has a slight effect on cardiac dysfunction. It is beneficial to improve the prognosis of children and is worthy of clinical promotion.