改良头低足高位对机器人辅助前列腺癌根治术后老年患者认知功能障碍的影响  

Effect of modified Trendelenburg position on cognitive dysfunction after robot-assisted radical prostatectomy in the elderly

作　　者：傅双[1] 李雪云[1] 芮琳[1] 华薇[1] FU Shuang;LI Xue-Yun;RUI Lin;HUA Wei(Anesthesia Surgery Department,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉手术科,南京210008

出　　处：《中华老年多器官疾病杂志》2021年第7期523-526,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的评估改良头低足高位与传统特伦德伦伯(氏)卧位(Trendelenburg)体位在机器人辅助腹腔镜前列腺癌根治术中对老年患者术后认知功能障碍的影响。方法选取2019年6月至10月南京大学医学院附属鼓楼医院择期行机器人辅助腹腔镜前列腺癌根治术患者82例,其中行传统Trendelenburg体位摆放的患者40例(传统组),行改良头低足高位摆放的患者42例(改良组)。全身麻醉插管后,分别于建立气腹前(T_(0))、气腹后10 min(T_(1))、摆放体位后10 min(T_(2))、摆放体位后60 min(T_(3))及停气腹平卧后10 min(T 4)记录脑氧饱和度(rSO_(2))、同时于术前1 d进行迷你精神状态检查(MMSE),并通过MMSE评分量表于术后第1、3、7天进行术后神经认知评估。采用SPSS 18.0软件进行数据分析。组间比较采用t检验,组内比较采用重复测量方差分析。结果2组患者在T_(0)和T_(1)时刻rSO_(2)比较,差异均无统计学意义(均P>0.05);传统组患者在T_(2)、T_(3)和T 4时刻rSO_(2)分别为(79±8)%、(80±9)%和(72±10)%,改良组患者分别为(71±6)%、(77±8)%和(69±9)%,差异均有统计学意义(均P<0.05)。2组患者在术前及术后第7天MMSE评分比较,差异均无统计学意义(均P>0.05);传统组患者术后第1、3天MMSE评分分别为(17.9±3.0)、(21.3±2.1)分,改良组分别为(24.6±2.0)、(25.2±2.2)分,差异均有统计学意义(均P<0.05)。结论改良头低足高位能显著降低传统Trendelenburg体位带来的脑血流量增加,同时改善患者术后认知功能障碍。Objective To evaluate the effect of modified Trendelenburg position in contrast to conventional Trendelenburg position on postoperative cognitive dysfunction in the elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods A total of 82 patients who underwent elective robot-assisted laparoscopic radical prostatectomy were selected.Among them,40 were placed in the conventional Trendelenburg position,and 42 in a modified Trendelenburg position.After intubation under general anesthesia,the cerebral oxygen saturation was recorded prior to pneumoperitoneum(T_(0)),10 minutes after pneumoperitoneum(T_(1)),10 minutes after posture(T_(2)),60 minutes after posture(T_(3)),and 10 minutes after supine abdominal prone(T 4),and the mini-mental state examination was performed on the day before the operation,and the postoperative neurocognitive assessment was performed on day 1,3,and 7 after the operation.SPSS statistics 18.0 was used for data analysis,t test was used for intergroup comparison,and variance analysis for intragroup comparison.Results There was no significant difference in rSO_(2)between the two groups at T_(0)and T_(1)(all P>0.05).In the traditional group,cerebral oxygen saturation(rSO_(2))at T_(2),T_(3)and T 4 was(79±8)%,(80±9)%and(72±10)%.In the modified posture group,rSO_(2)at T_(2),T_(3)and T 4 was(71±6)%,(77±8)%and(69±9)%.The differences were statistically significant(all P<0.05).There was no significant difference in mini-mental state examination(MMSE)scores between the two groups before and 7 days after operation(all P>0.05).The MMSE scores of the conventional posture traditional group on the first and third day after operation were(17.9±3.0),(21.3±2.1)points.The MMSE scores of the modified posture group on the first and third day after operation were(24.6±2.0),(25.2±2.2)points.The difference was statistically significant(all P<0.05).Conclusion The modified Trendelenburg position can significantly reduce the increase of cerebral blood flow caused by the conventional Tren

关 键 词：老年人 改良头低足高位 特伦德伦伯(氏)卧位 机器人辅助手术 前列腺癌根治术 脑血流动力学 

分 类 号：R683[医药卫生—骨科学] R592[医药卫生—外科学]