不同气腹压力下腹腔镜胃结肠癌手术对围术期血糖及术后认知功能障碍的影响  

作　　者：谢鹏 贺小武 王立 余力栋 严烁 周建平 

机构地区：[1]浙江中医药大学,310053 [2]中国人民解放军联勤保障部队第九〇六医院,315040

出　　处：《浙江临床医学》2023年第7期996-998,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨不同气腹压力下腹腔镜胃结肠癌手术对围术期血糖(BG)水平及术后认知功能障碍(POCD)的影响。方法行腹腔镜胃结肠癌术患者253例,随机分为低腹压(6~8 mmHg)组(LPP组)125例和高腹压(12~14 mmHg)组(HPP组)128例。术前1 d、术后1 d、7 d采用简易精神状态检查(MMSE)测试评估认知功能。比较两组患者血清C反应蛋白(CRP)、IL-6水平及围术期血糖水平。结果HPP组21例(16.4%)、LPP组5例(4.0%)发生早期POCD。HPP组腹腔镜手术中T4~T6 BG水平明显高于LPP组(P<0.05)。HPP组POCD患者的最高血糖(BG max)、血糖最大升幅(BG max%)、血糖最大升幅基线(BG max-baseline)明显高于非POCD患者(P<0.05)。血糖水平升高≥3 mmol/L是HPP组患者术中发生POCD的预测因素。结论腹腔镜胃结肠癌术中保持LPP有利于减少POCD。HPP可诱导术中血糖升高,引起早期POCD的发生。术中监测血糖可能有助于预测POCD的发生。Objective To investigate the relationship between Postoperative cognitive dysfunction(POCD)and Blood Glucose(BG)level peri-operation in patients undergoing laparoscopic gastrocolonic cancer surgery.Methods 253 patients with gastrocolonic cancer were engaged in the study and divided randomly into the low peritoneal pressure(LPP)(6~8 mmHg)(n=125)group and the high peritoneal pressure(HPP)(12~14 mmHg)(n=128)group for elective laparoscopic surgery.The cognitive function was evaluated by the Mini-Mental State Examination Test 1 day pre-operatively and 1day,7day post-operatively.Serum levels of C-reactive protein(CRP),IL-6 were compared between the two groups.Blood glucose levels were also continuously monitored peri-operation.Results 21 patients(16.4%)in the HPP group and 5 patients(4.0%)in the LPP group suffered from early POCD.We found that BG level was significantly higher at t4 to t6 in HPP group during the laparoscopic surgery than in the LPP group(P<0.05).Maximum BG(BG max),maximum percentage rise in BG(BG max%),maximum rise in BG(BG max-baseline)were also observably greater in the POCD patients than non-POCD patients in HPP group(P<0.05).BG level increase≥3 mmol/L was a significant intra-operative predictor for POCD in HPP.Conclusion Maintaining low pneumoperitoneum pressure during laparoscopic gastrocolonic cancer surgery is beneficial to reduce the influence on postoperative cognitive function.HPP can induce greater intra-operative increase of blood glucose to promote the occurrence of early POCD.Monitoring of blood glucose intra-operation might be useful in the prediction of POCD.

关 键 词：腹腔镜手术 术后认知功能障碍 气腹压力 血糖 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]