压力控制机械通气模式对腹腔镜结直肠癌根治术老年患者术后认知功能的影响及可能机制  

The effect of the pressure control mechanical ventilation mode on postoperative congnitive function in aged patients with laparoscopic surgery

作　　者：陆艳霞 李荣[1] LU Yanxia;LI Rong(The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院,内蒙古包头014010

出　　处：《包头医学院学报》2022年第5期24-28,59,共6页Journal of Baotou Medical College

摘　　要：目的:探讨压力控制通气模式对腹腔镜结直肠癌根治术老年患者术后认知功能的影响。方法:选取2019年11月~2020年11月在本院头低脚高位下行腹腔镜结直肠癌根治术的老年患者60例,随机数字表法分为两组,分别采用容量控制通气+呼气末正压(VCV+PEEP,VP组),压力控制通气+呼气末正压(PCV+PEEP,PP组),每组各30例。记录麻醉诱导前(T0),麻醉诱导后(T1)、人工气腹后30 min(T2)、60 min(T3)、人工气腹后90 min(T4)、120 min(T5)和关闭气腹(T6)拔管后(T7)八个时间点的呼吸力学指标[气道峰压、气道平均压、分钟通气量(MV)]、血流动力学指标(血压、心率、平均动脉压),在T0、T3、T7三个时间点采集动脉血做血气分析,并根据测量值计算氧合指数(oxygenation index),并观察术前和术后24 h(T8)患者血氧饱和度(SpO_(2)),记录术后24 h低氧血症的发生率;并于T0、T7两个时间点抽取静脉血采用酶联免疫吸附测定法(ELISA)测定血清中肿瘤坏死因子(TNF-a)、白细胞介素6(IL-6)的含量,手术前1d,术后1、3、7d采用目前常用的MMSE量表进行认知功能测定。结果:PP组在T1~T6时间点的Ppeak值和Pmean值显著低于VP组(P<0.05);两组患者在4个时间点MMSE测量值变化幅度差异有统计学意义,且VP组术后1d的下降幅度较PP组明显;血清TNF-a和IL-6水平在T3、T6时间点,VP组显著高于PP组;术后24 h PP组氧饱和度显著高于VP组;两组在T3、T7时间点氧合指数比较,PP组显著高于VP组。结论:压力控制机械通气可降低行腹腔镜下结直肠癌根治术老年患者围术期神经认知功能障碍(perioperative neurocognitive dysfunction,PND)的发生率,其机制可能与压力控制降低气道压,降低血清炎症因子TNF-a和IL-6水平从而减轻肺部炎症反应有关。Objective:To investigate the effect of pressure control ventilation mode on postoperative cognitive function of elderly patients undergoing laparoscopic surgery.Methods:From November 2019 to November 2020,60 elderly patients with laparoscopic radical resection of colorectal cancer in our hospital were selected and randomly divided into two groups,with 30 cases in each group.They were treated with volume control ventilation+positive end expiratory pressure(VCV+PEEP,VP group)and pressure control ventilation+positive end expiratory pressure(PCV+PEEP,PP group).The respiratory mechanics indexes[peak airway pressure,mean airway pressure,minute ventilation(MV)]and hemodynamic indexes(blood pressure,heart rate,mean arterial pressure)were recorded before induction of anesthesia(T0),10 min after induction of anesthesia(T1),30 min after artificial pneumoperitoneum(T2),60min after artificial pneumoperitoneum(T3),90 min after artificial pneumoperitoneum(T4),120 min after artificial pneumoperitoneum(T5),closed pneumoperitoneum(T6)and after extubation(T7).Arterial blood samples were collected at TO,T3 and T7 for blood gas analysis.The oxygenation index was calculated according to the measured value,and the SpO_(2) of patients before and after 24 h(T8)was observed,and the incidence of hypoxemia after 24 h was recorded.Venous blood was collected at T0 and T7,and the levels of tumor necrosis factor-a(TNF-a)and interleukin-6(IL-6)in serum were measured by enzyme-linked immunosorbent assay(ELISA).The cognitive function was measured by the commonly used MMSE scale on the 1st day before operation,1st,3rd and 7th day after operation.Results:The Ppeak and Pmean values at T1-T6 in PP group were significantly lower than those in VP group(P<0.05).There was a statistically significant difference in the changes of MMSE measurement values between the two groups at four time points,and the decrease in VP group on the 1st day after operation was more obvious than that in PP group.The levels of serum TNF-a and IL-6 in VP group were significantly

关 键 词：结直肠癌根治术 腹腔镜 压力控制机械通气 神经认知功能 炎症反应 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]