Objective: To explore the effects of permissive hypercapnia on postoperative cognitive function in elderly patients with diabetes mellitus.
Methods: Sixty elderly patients with diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia, were randomly divided into two groups: the permissive hypercapnia ventilation diabetes mellitus group (group DH) and the routine ventilation diabetes mellitus group (group DR), 30 patients in each group. Another sixty elderly patients with non-diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia, were randomly divided into two groups: the permissive hypercapnia ventilation non-diabetes mellitus group (group NH) and the routine ventilation group (group NR), 30 patients in each group. All patients in four groups were performed with tracheal intubation and mechanical ventilation after anesthesia induction. The respiratory parameters were adjusted to maintain PaCO2 in a range of 45-65 mmHg in groups DH and NH, and PaCO2 in a range of 35-45 mmHg in groups DR and NR. PETCO2 was recorded 5 minutes before pneumoperitoneum, 5, 15, and 30 minutes after pneumoperitoneum. Blood samples were taken from the radial artery and jugular bulb for blood gas analysis 5 minutes before pneumoperitoneum, 5, 15, and 30 minutes after pneumoperitoneum. pH value and PaCO2 were recorded and arterial internal jugular vein bulbar oxygen difference (Da-jvO2) and cerebral oxygen extraction rate (CERO2) were calculated at the same time. The serum S100β protein concentration were detected before anesthesia induction and 3 days after operation. Montreal cognitive assessment (MoCA) scores and occurrence of postoperative cognitive dysfunction were recorded 1 day before operation, and 1 day, 3 days and 7 days after operation.
Results: Compared with the baseline value 5 minutes before pneumoperitoneum, PETCO2 and PaCO2 were significantly increased, pH value, Da-jvO2 and CERO2 were significantly decreased 5, 15, and 30 minutes after pneumoperitoneum in the four groups (P < 0.05). Compared with before anesthesia induction, the serum S100β protein concentration were significantly increased 3 days after operation in the four groups (P < 0.05). Compared with the last day before operation, MoCA scores were significantly decreased 1 day and 3 days after operation in the four groups (P < 0.05). Compared with group DR, PETCO2 was significantly increased, pH value, Da-jvO2, and CERO2 were significantly decreased 5 minutes before pneumoperitoneum, 5, 15, and 30 minutes after pneumoperitoneum, the serum S100β protein concentration was significantly decreased 3 days after operation, MoCA scores were significantly increased 1 day and 3 days after operation, the incidence rate of POCD was significantly decreased in group DH (P < 0.05). Compared with group NR, PETCO2 was significantly increased, pH value, Da-jvO2, and CERO2 were significantly decreased 5 minutes before pneumoperitoneum, 5, 15, and 30 minutes after pneumoperitoneum, the serum S100β protein concentration was significantly decreased 3 days after operation, MoCA scores were significantly increased 1 day and 3 days after operation, the incidence rate of POCD was significantly decreased in group NH (P < 0.05). Compared with group NH, Da-jvO2 and CERO2 were significantly increased 5 minutes before pneumoperitoneum, 5, 15, and 30 minutes after pneumoperitoneum, the serum S100β protein concentration was significantly increased 3 days after operation, MoCA scores were significantly decreased 1 day and 3 days after operation in group DH (P < 0.05).
Conclusion: Permissive hypercapnia can improve the cerebral oxygen metabolism during operation, reduce postoperative serum S100β protein concentration and reduce the incidence rate of POCD in the elderly patients with diabetes mellitus. |
