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

摘要

Objective To investigate the effect of different pressure CO 2 pneumoperitoneum on early postoperative cognitive function in female patients undergoing gynecological laparoscopic sur-gery.Methods Ninety female patients,aged 40-60 years,ASA physical status Ⅰor Ⅱ,scheduled for elective gynecological laparoscopic surgery,were randomly divided into three groups (n = 30). The pressure of CO 2 pneumoperitoneum were set at 6-8,9-1 1 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 sam-ples 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 S100βprotein.The pH,PaCO 2 and PaO 2 were recorded before anesthesia (Ta ),before pneumoperitoneum (Tb ),1 hour after pneumoperitoneum (Tc ),2 hours after pneumo-peritoneum (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.Com-pared 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 S100βprotein 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,PaCO 2 was significantly increased at Tc-Te in groups M and H (P <0.05).Conclusion Different pressure of CO 2 pneumoperitoneum has no ob-vious effect on the early cognitive function,but low (6-8 mm Hg)CO 2 pneumoperitoneum can reduce the release of NSE and S100βprotein after operation.%目的：研究不同压力 CO 2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、PaCO 2和 PaO 2。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PaCO 2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。