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 Carbon Dioxide Pneumoperitoneum on Postoperative Cognitive Dysfunction in Female Patients Undergoing Gynecological Laparoscopy

目的 探讨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.方法 ASA分级为Ⅰ级的215例妇科手术患者接受传统开腹手术（非气腹组, n=100）或二氧化碳气腹下腹腔镜手术（气腹组,n =115）.麻醉诱导静注丙泊酚1.5～2mg/kg,芬太尼4μg/kg,琥珀胆碱1.5mg/kg,气管插管后行机械通气,用1.5 %～2%的异氟烷维持麻醉.在术前1d、术后1、6、24、48、72h和出院前记录患者血压、心率和认知功能MMSE值的变化和气腹或手术开始后1.5h的动脉和呼气末二氧化碳分压.结果 两组的一般临床资料和住院期间的血流动力学没有明显差异.非气腹组与气腹组比较认知功能在术后1、6、24、 48、72h MMSE值明显降低（P＜0.01）.结论 二氧化碳气腹可明显影响妇科腹腔镜手术患者的术后早期认知功能.

Objective To investigate the effect of carbon dioxide pneumoperitoneum on postoperative cognitive dysfunction in female patients undergoing gynecological laparoscopy. Methods 225 ASA physical status Ⅰpatients were to receive either no insufflation to do conventional abdominal surgery（n=100,group Ⅰ ） or receive abdominal insuffiation to gynecological laparoscopy（n= 115,group Ⅱ ）.Anesthesia was induced with propofol（1.5 - 2mg/kg）, fentanyl（4μg/kg）, succinylcholine（1.5mg/kg）,and maintained with isoflurane （end-tidal concentration, 1.5% - 2%） in 100% oxygen.Blood pressure,Heart Rate,EτCO2,PaCO2,and MMSE were recorded 1 day before operation,just before operation and 1,6,24,48,and 72h after operation. Results There were no significant difference between the two groups in relevant medical history or hemodynamics during hospital. MMSE value was significantly decreased at 1、6、24、48、 72h after operation in groupⅡ （24 ± 1.52;26± 1.53;27 ± 1.64;28 ＋ 1.73;28 ±1.83）,compared with group I （28 ±1.03;28 ＋ 0.99;29 ± 0.83;29 ± 0.78;29 ± 0.75）（P〈0.01）. Conclusions CO2 pneumoperi- toneum significantly affect postoperative cognitive function in female patients undergoing gynecological laparoscopy.