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| 不同压力二氧化碳气腹对妇科腹腔镜手术患者术后早期认知功能的影响 |
| Effect of different pressure CO2 pneumoperitoneum on early postoperative cognitive function in female patients undergoing gynecological laparoscopic surgery |
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| DOI： |
| 中文关键词: 人工气腹 腹腔镜手术 妇科手术 认知功能 |
| 英文关键词: Artificial pneumoperitoneum Laparoscopic surgery Gynecological surgery Cognitive function |
| 基金项目:安徽医科大学校科研基金资助项目（2015xkj150） |
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| 中文摘要: |
| 目的 研究不同压力CO2气腹对妇科腹腔镜手术患者术后早期认知功能的影响。方法 选择择期行妇科腹腔镜手术患者90例,年龄40～60岁，ASA Ⅰ或Ⅱ级，采用随机数字表法将患者分为三组,每组30例。L组、M组和H组气腹压力分别为6～8、9～11和12～14 mm Hg。所有患者术前24 h、术后24 h和72 h进行神经心理学测验和问卷调查,根据评分测验结果判断患者术后认知功能是否降低。于麻醉诱导前10 min(T1)、术毕(T2)、术后6 h(T3)、24 h(T4)和72 h(T5)检测静脉血神经元特异性烯醇化酶(NSE)和S100β蛋白含量。记录麻醉诱导前(Ta)、气腹前(Tb)、气腹后1 h(Tc)、2 h(Td)及停止气腹后1 h(Te)的动脉血pH、PaCO2和PaO2。结果 三组不同时点神经心理学测试得分差异无统计学意义,从测试结果中未能得出各组患者术后早期认知功能下降。T2、T3时L组和M组NSE含量明显低于H组(P＜0.05);T2时L组和M组S100β蛋白含量明显低于H组(P＜0.05)。Tc、Td时M组和H组pH明显低于L组(P＜0.05),Tc～Te时M组和H组PaCO2明显高于L组(P＜0.05)。结论 不同压力二氧化碳气腹对术后早期认知功能未见明显影响,但低压力（6～8 mm Hg）二氧化碳气腹明显减少患者术后血液中NSE及S100β蛋白的释放。 |
| 英文摘要: |
| Objective To investigate the effect of different pressure CO2 pneumoperitoneum on early postoperative cognitive function in female patients undergoing gynecological laparoscopic surgery. Methods Ninety female patients, aged 40-60 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective gynecological laparoscopic surgery, were randomly divided into three groups (n=30). The pressure of CO2 pneumoperitoneum were set at 6-8, 9-11 and 12-14 mm Hg in groups L, M and H, respectively. All of the patients were tested by the neuropsychology and questionnaire review to estimate whether the patient got cognitive decline at 24 h before the operation. The venous blood samples 10 minutes before anesthesia (T1), at the end of surgery (T2), 6 hours after surgery (T3), 24 hours after surgery (T4) and 72 hours after surgery (T5) were collected for determination of serum concentrations of NSE and S100β protein. The pH, PaCO2 and PaO2 were recorded before anesthesia (Ta), before pneumoperitoneum (Tb), 1 hour after pneumoperitoneum (Tc), 2 hours after pneumoperitoneum (Td) and 1 hour after stopping pneumoperitoneum (Te). Results Scores of these tests in three groups were not different and there was no patient with cognitive decline after surgery. Compared with group H, the concentration of NSE at T2 and T3 was significantly lower in groups L and M (P＜0.05). Compared with group H, the concentration of S100β protein at T2 was significantly lower in groups L and M (P＜0.05). Compared with group L, pH at Tc and Td was significantly decreased in groups M and H (P＜0.05). Compared with group L, PaCO2 was significantly increased at Tc-Te in groups M and H (P＜0.05). Conclusion Different pressure of CO2 pneumoperitoneum has no obvious effect on the early cognitive function, but low (6-8 mm Hg) CO2 pneumoperitoneum can reduce the release of NSE and S100β protein after operation. |
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