不同CO2气腹压力对老年患者全麻腹腔镜术后认知功能的影响  

Effect of different CO2 pneumoperitoneum pressure on cognitive function of elderly patients after general anesthesia laparoscopic surgery

作　　者：李侠[1] 何文胜[1] 陈亮[1] 李元海[2] LI Xia;HE Wensheng;CHEN Liang;LI Yuanhai(Department of Anesthesiology,the Second People′s Hospital of Hefei,Anhui Province,Hefei230000,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Anhui Province,Hefei230000,China)

机构地区：[1]合肥市第二人民医院麻醉科,安徽合肥230000 [2]安徽医科大学第一附属医院麻醉科,安徽合肥230000

出　　处：《中国医药导报》2020年第22期101-105,共5页China Medical Herald

摘　　要：目的探讨不同CO2气腹压力对老年患者全麻腹腔镜手术术后认知功能的影响。方法选取2017年12月—2019年1月合肥市第二人民医院收治的60例拟行全麻腹腔镜手术的老年患者为研究对象。按照气腹压力高低将其分为低气压组(6~8 mmHg)、中气压组(9~11 mmHg)、高气压组(12~14 mmHg),每组20例。比较三组气腹前,气腹后0.5、1 h,气腹结束后0.5 h心率(HR)、平均动脉压(MAP)、动脉血CO2分压(PaCO2)水平;比较三组麻醉前10 min,手术结束时,术后6、24 h静脉血神经元特异性烯醇化酶(NSE),S100β水平;评价三组术前1 d,术后6、24 h简易精神状态量表(MMSE)评分。结果高气压组气腹后0.5、1 h的HR水平高于低气压组,差异均有统计学意义(均P<0.05)。中、高气压组气腹后0.5、1 h的MAP水平高于低气压组,差异均有统计学意义(均P<0.05)。中、高气压组气腹后0.5、1 h的PaCO2水平高于低气压组,高气压组气腹结束后0.5 h的PaCO2水平高于低气压组,差异均有统计学意义(均P<0.05)。高气压组手术结束时、术后6 h的NSE水平高于低、中气压组,且中气压组高于低气压组,差异均有统计学意义(均P<0.05)。中、高气压组手术结束时的S100β水平高于低气压组,且高气压组高于中气压组,差异均有统计学意义(均P<0.05)。三组不同时间点MMSE评分比较,差异均无统计学意义(均P>0.05)。结论不同CO2气腹压力对老年患者全麻腹腔镜手术术后认知功能无明显影响,低气压可能降低术后认知功能障碍的发生风险。Objective To explore the influence of different CO2 pneumoperitoneum pressure on cognitive function of elderly patients after general anesthesia laparoscopic surgery.Methods From December 2017 to January 2019,60 cases with elderly patients who undergoing general anesthesia laparoscopic surgery were selected in the Second People′s Hospital of Hefei.According to the pneumoperitoneum pressure,they were divided into low pressure group(6-8 mmHg),medium pressure group(9-11 mmHg),high pressure group(12-14 mmHg),with 20 cases in each group.The heart rate(HR),mean arterial pressure(MAP),arterial blood CO2 partial pressure(PaCO2)of three groups at before pneumoperitoneum,half an hour and one hour after pneumoperitoneum,half an hour after the end of pneumoperitoneum were compared;neuron specific enolase(NSE)and S100βat ten minutes before anesthesia,end of operation,6 h and 24 h after operation were compared;the mini mental state scale(MMSE)of three groups were evaluated at one day before surgery,6 and 24 h after surgery.Results HR levels at half an hour and one hour after pneumoperitoneum in high pressure group were higher than those in low pressure group,with statistically significant differences(all P<0.05).MAP levels at half an hour and one hour after pneumonperitoneum in middle and high pressure groups were higher than those in low pressure group,with statistically significant differences(all P<0.05).The PaCO2 levels at half an hour and one hour after pneumoperitoneum in middle and high pressure groups were higher than those in low pressure group,and the PaCO2 levels at half an hour end of the pneumoperitoneum in high pressure group were higher than those in low pressure group,with statistically significant differences(all P<0.05).The NSE protein levels at the end of operation and six hours after operation of high pressure groups were higher than those of low and middle pressure group,and middle pressure group was higher than low pressure group,with statistically significant differences(all P<0.05).The S100βprotein

关 键 词：腹腔镜手术 老年患者 术后认知功能障碍 人工气腹 全麻 

分 类 号：R614[医药卫生—麻醉学]