妇科腹腔镜与开腹手术对老年患者术后认知功能的影响

Effect of gynecological laproscope and abdominal surgery on postoperative cognitive dysfunction in elderly patients

目的探讨腹腔镜手术与开腹手术对妇科老年患者早期认知功能障碍的影响及血清S100β差异。方法选取妇科60例择期行腹腔镜手术和开腹手术老年患者,在全身麻醉（全麻）下分别接受手术,术前1 d及术后1 d采用简易智力状态检查表（MMSE）行认知功能评价。在麻醉诱导前（T1）、拔管前（T2）、术后6 h（T3）、术后24 h（T4）行血清S100β浓度测定。结果术后24 h腹腔镜组较术前降低,分值为（-1.3±2.93）分,开腹组为（-4.85±3.76）分,两组比较差异有统计学意义（P〈0.05）。开腹组T2~4血清S100β浓度高于T1,腹腔镜组T3、T4高于T1,腹腔镜组T3、T4血清S100β浓度升高幅度低于开腹组（P〈0.05）。结论妇科开腹手术对患者术后认知功能影响较腹腔镜手术明显,并且可以通过血清S100β浓度反映出认知功能的损害程度。

Objective To study if different methods of operation will influence the postoperative cognitive function and the concentration of serum S-100β.Methods 60 female elderly gynecological patients undergoing elective abdominal surgery either laproscopic operation or laparotomy were selected and received general anesthesia.Cognitive function was assessed on 1 d preoperatively and 1 d postoperatively with MMSE.The level of serum S100βprotein was measured before anesthesia（T1）,before extubation（T2）,postoperative 6 h（T3） and 24 h（T4）.Results Compared to preoperative 1 d,the postoperative MMSE score declined in both groups.After laproscopic operation,the score decreased in some degree,but which in the laparotomy group was more significant（P〈0.05）.In the T2-4,the concentration of serum S100β was higher than that in T1 after laparotomy.In the laproscopic operation group,there was S100β elevation in T3 and T4.Compared to laparotomy group,the concentration of S100β was lower in any time point after laproscopic operation.Conclusion Laparotomy has more significant impact upon elderly patient′s postoperative cognitive function.The concentration of serum S100β may reflect the impairment of cognitive function.