CO2气腹压力对老年患者腹腔镜直肠癌手术后认知功能、脑应激因子及脑供氧水平的影响  

Effects of CO pneumoperitoneum pressure on postoperative cognitive function,brain stress factors and brain oxygen supply level in elderly patients undergoing laparoscopic rectal cancer surgery

作　　者：史斌 胡敬利 孙庆旭 SHI Bin;HU Jing-li;SUN Qing-xu(Department of Anesthesiology,Cancer Hospital of Linyi City,Linyi 276001,China;Department of General Surgery,Cancer Hospital of Linyi City)

机构地区：[1]临沂市肿瘤医院麻醉科,山东临沂276001 [2]临沂市肿瘤医院普通外科

出　　处：《腹腔镜外科杂志》2020年第7期529-533,共5页Journal of Laparoscopic Surgery

基　　金：山东省临沂市科技创新发展计划(医学类)(201919048)。

摘　　要：目的:观察不同CO2气腹压力对老年患者腹腔镜直肠癌术后认知功能、脑应激因子及脑供氧水平的影响。方法:为80例年龄≥60岁的中低位直肠癌患者行腹腔镜直肠癌前切除术,将患者随机分为CO2气腹低压力组(10 mmHg,低压组)与高压力组(15 mmHg,高压组),每组40例。分别于术前1 d及术后第1天、第3天、第7天采用简易智能精神状态检查量表判断术后认知功能障碍程度;术前1 d、术后第3天采用酶联免疫吸附法测定血清中枢神经特异性蛋白(S100β)、脑源性神经营养因子(BDNF)、β-淀粉样蛋白与微管相关蛋白比值(Aβ-42/tau)水平;于气腹前即刻(T0)、气腹后30 min(T1)、60 min(T2)、90 min(T3)进行血气分析。结果:术前1 d,两组智能精神状态评分差异无统计学意义(P>0.05),术后第1天、第3天、第7天,两组均较术前1 d出现不同程度降低(P<0.05),高压组降低更明显(P<0.05)。术前1 d,两组血清S100β、BDNF、Aβ-42/tau水平差异无统计学意义(P>0.05);术后第3天,两组血清S100β水平升高(P<0.05),BDNF及Aβ-42/tau水平下降(P<0.05);低压组S100β水平低于高压组,BDNF、Aβ-42/tau水平高于高压组,差异有统计学意义(P<0.05)。与T0相比,T1、T2、T3时,两组颈静脉球血氧饱和度、动脉血二氧化碳分压均增加(P<0.05),脑动脉-颈内静脉血氧含量差减少(P<0.05)。结论:腹腔镜手术中采用较低的CO2气腹压力可减少老年患者术后认知功能障碍发生风险,改善脑应激因子水平、大脑氧代谢。Objective:To observe the effects of different CO2 pneumoperitoneum pressure on cognitive function,brain stress factors and brain oxygen supply level after laparoscopic surgery for elderly rectal cancer.Methods:Eighty patients of middle and low rectal cancer underwent laparoscopic anterior resection of rectal cancer with age≥60 years,and they were randomly divided into the CO2 pneumoperitoneum low-pressure group(10 mmHg)and the high-pressure group(15 mmHg),with 40 cases in each group.The mini-mental state examination(MMSE)was used to judge the degree of postoperative cognitive dysfunction one day before surgery and one day,three days and seven days after surgery.Serum levels of S100β,brain-derived neurotrophic factor(BDNF)and Aβ-42/tau were measured by enzyme linked immunosorbent assay one day before and three days after surgery.Blood gas analysis was performed immediately before the pneumoperitoneum(T0),30 min(T1),60 min(T2),and 90 min(T3)after the pneumoperitoneum.Results:There was no significant difference in MMSE score between the two groups before anesthesia(P>0.05),and the two groups showed different degrees of decrease on day 1,day 3,and day 7 after surgery compared with those before anesthesia(P<0.05),and the decrease was more significant in the high-pressure group(P<0.05).Before anesthesia,there was no significant difference in serum S100β,BDNF and Aβ-42/tau levels between the two groups(P>0.05).On postoperative day 3,serum S100βlevels of the two groups were significantly increased(P<0.05),while levels of BDNF and Aβ-42/tau levels were significantly decreased(P<0.05).After surgery,the level of S100βin the low-pressure group was significantly lower than that in the high-pressure group on day 3,and the level of BDNF and Aβ-42/tau was significantly higher than that in the high-pressure group(P<0.05).Compared with T0,jugular bulb venous oxygen saturation and PaCO2 increased significantly at T1,T2 and T3(P<0.05),and cerebral arterial-jugular venous oxygen difference decreased significantly(P<0.05).Co

关 键 词：直肠肿瘤 腹腔镜检查 认知 脑应激因子 脑氧代谢 老年人 

分 类 号：R735.37[医药卫生—肿瘤]