术中调控不同呼气末二氧化碳分压对老年腹腔镜手术患者术后认知功能的影响

发布时间：2018-05-23 17:54

本文选题：呼气末二氧化碳分压 + 腹腔镜　；参考：《临床麻醉学杂志》2013年10期

【摘要】：目的探讨术中维持不同的PET CO2值对老年腹腔镜手术患者术后认知功能的影响。方法择期全麻下行腹腔镜胆囊切除术和腹腔镜胆囊切除胆总管切开取石"T"管引流术的患者50例,年龄65~75岁,体重45~70kg,随机均分为两组,L组,术中通过调控呼吸参数维持气腹后PET CO2在35~39mm Hg;H组,维持PET CO2在40~45 mm Hg,每组25例。记录气腹前5 min(T0)、气腹后5min(T1)、15min(T2)、30min(T3)的PET CO2及VT、RR、气道峰压(Ppeak),同时于T0~T3时分别采集桡动脉血及颈内静脉球部血行血气分析,计算动-静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)。于术前1d及术后3d行简易智力状态检测(MMSE)、数字广度(顺、逆)、数字符号、循迹连线、词汇流畅性和单词辨认测试。结果与T0时比较,T1~T3时两组Ppeak明显升高,Da-jvO2、CERO2明显降低;T1~T3时L组VT、RR明显增快,T2、T3时PET CO2、PaCO2明显升高;T2、T3时H组RR明显增快,T1~T3时PET CO2、PaCO2明显升高(P0.05)。与H组比较,L组T1~T3时VT明显升高RR明显增快,T2、T3时Ppeak明显升高,T1~T3时PET CO2、PaCO2明显降低,T3时Da-jvO2、CERO2明显升高(P0.05)。与H组比较,L组术后3d单词辨认明显降低(P0.05)。与术前1d比较,术后3d两组MMSE、数字广度(逆)、数字符号、明显降低循迹连线明显升高,L组数字广度(顺)、词汇流畅性单词辨认明显降低(P0.05)。结论术中调控PET CO2在40~45mm Hg可减轻老年患者腹腔镜术后短时字词记忆能力损害,改善POCD,且术中呼吸参数调整较平稳。
[Abstract]:Objective to investigate the effect of maintaining different PET CO2 values during operation on postoperative cognitive function in elderly patients undergoing laparoscopic surgery. Methods 50 patients with laparoscopic cholecystectomy and laparoscopic cholecystectomy with choledocholithotomy and "T" tube drainage under general anesthesia were randomly divided into two groups. After pneumoperitoneum, PET CO2 was maintained in 35~39mm HgG H group and PET CO2 was maintained at 40 ~ 45 mm Hg in each group by adjusting respiratory parameters. 25 cases in each group were treated with Pneumoperitoneum (Pneumoperitoneum). Five minutes before pneumoperitoneum and five minutes after pneumoperitoneum, the PET CO2 and VTV-RRR were recorded, and the peak airway pressure was measured. At the same time, the radial artery blood and the jugular blood of internal jugular vein were collected for blood gas analysis during T0~T3, and the difference in blood oxygen content of arteriovenous blood (Da-jvO2) and cerebral oxygen uptake rate (CERO2P) were calculated. A simple mental state test was performed 1 day before operation and 3 days after operation, including MMSE, digit span (converse, inverse, digital symbol, trace line, lexical fluency and word recognition test). Results compared with T _ (0), Ppeak in two groups were significantly higher than that at T _ (1) T _ (3) and PET CO _ (2) PaCO _ 2 in T _ (2) T _ (3) group was significantly higher than that in T _ (2) T _ 3 group. The level of PET CO _ (2) PaCO _ (2) in T _ (1) T _ 3 group was significantly higher than that in T _ (2) T _ 3 group. The PET CO _ (2) PaCO _ 2 in T _ (2) T _ 3 group was significantly higher than that in T _ (2) T _ 3 group. Compared with H group, VT increased significantly at T1~T3 in L group. Ppeak increased significantly in T _ 2 and T _ 3. P0.05 increased in T _ (2) T _ (2) T _ (2) and PET CO _ (2) O _ (2) PaCO _ (2) in T _ (1) T _ (3) and Da-jvO _ (2) CERO2 in T _ (3). Compared with group H, the recognition of words in group L was significantly lower than that in group H 3 days after operation (P 0.05). Compared with 1 day before operation, MMSE, digit span (inverse, digital symbol) were significantly decreased in both groups on the 3rd day after operation. The number span of group L was significantly increased with the increase of trace line (P < 0.05), and the word recognition of lexical fluency was significantly lower than that of group L (P < 0.05). Conclusion Intraoperative regulation of PET CO2 in 40~45mm Hg can reduce the impairment of short-term word memory after laparoscopic surgery, improve the ability of 40~45mm, and adjust the respiratory parameters smoothly during operation.
【作者单位】：安徽医科大学第一附属医院麻醉科;桐城市人民医院麻醉科;
【分类号】：R614

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