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

发布时间：2018-03-12 09:19

本文选题：人工气腹　切入点：腹腔镜手术　出处：《临床麻醉学杂志》2017年02期 　论文类型：期刊论文

【摘要】：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,ASAⅠ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12~14mm Hg。所有患者术前24h、术后24h和72h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10min(T_1)、术毕(T_2)、术后6h(T_3)、24h(T_4)和72h(T_5)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(T_a)、气腹前(T_b)、气腹后1h(T_c)、2h(T_d)及停止气腹后1h(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。T_2、T_3时L组和M组NSE含量明显低于H组(P0.05);T_2时L组和M组S100β蛋白含量明显低于H组(P0.05)。T_c、T_d时M组和H组pH明显低于L组(P0.05),T_c~T_e时M组和H组PaCO_2明显高于L组(P0.05)。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(6~8mm 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。
[Abstract]:Objective to study the effect of different pressure CO_2 pneumoperitoneum on the early cognitive function of patients undergoing gynecologic laparoscopic surgery. The patients were divided into three groups by random digital table. The pneumoperitoneum pressure of group M and group H were 6 / 8 / 9 / 11 and 12 / 14 mm / h respectively. Neuropsychological tests and questionnaires were performed 24 hours before operation, 24 hours and 72 hours after operation. According to the result of score test, the cognitive function of patients after operation was determined. 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min after anesthesia, after operation, after operation, T2P, 6 h after operation, 6 h after operation, 6 h after operation, the levels of NSEs and S100 尾 protein in venous blood were detected. The contents of NSEs and S100 尾 protein were measured before anesthesia induction. Results there was no significant difference between the three groups in the scores of Paco _ 2 and Pao _ 2 at 1 hour after pneumoperitoneum, 1 h after pneumoperitoneum and 1 h after cessation of pneumoperitoneum. From the results of the test, it can not be concluded that the levels of NSE in group L and group M are significantly lower than those in group H at the time of P0.05 and T2 after operation. The content of S100 尾 protein in group L and M is significantly lower than that in group H (P0.05N. Tctid). The pH of group M and group H is significantly lower than that of group H at day 3. The PaCO_2 of group M and group H were significantly higher than that of group L (P 0.05). Conclusion there is no significant effect on early cognitive function of patients with different pressure of carbon dioxide pneumoperitoneum. However, the release of NSE and S100 尾 protein in the blood of the patients after pneumoperitoneum was significantly reduced by hypobaric carbon dioxide pneumoperitoneum.
【作者单位】：安徽医科大学附属安庆医院麻醉科;安徽医科大学第一附属医院麻醉科;

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