二氧化碳气腹对妇科腹腔镜手术患者术后早期认知功能S-100β和NSE的影响

Effect of carbon dioxide pneumoperitoneum on the level of serum S-100β and NSE proteins 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S-100β和NSE的变化.方法 选全麻下择期妇科腹部手术60例,分为两组,非气腹组：传统开腹手术30例,二氧化碳气腹腹腔镜手术30例患者.观察患者术前1 d、术后1、6、24、48、72 h和出院前患者认知功能MMSE值变化和术前,术后1h采静脉血用ELISA法血清测定S-100β蛋白和NSE浓度.结果 气腹组MMSE评分在术后1、6、24、48、72 h各时点（24.67±1.47,25.97±1.50,26.77±1.61,27.07±1.87,27.37±2.06）较术前（29.17±0.76）或非气腹组（27.63±1.33,27.27±0.87,28.37±0.85,28.73±0.78）,较术前（29.23±0.86）明显降低（P〈0.01）.术后1 h气腹组和非气腹组S-100β[（0.114±0.012,0.086±0.009）μg/L]和NSE[（13.720±1.330,12.093±0.697）μg/L]与术前[（0.035±0.030,0.035±0.024;5.753±0.889,5.831±0.967）μg/L]相比均明显增高（P〈0.01）.与非气腹组[（0.086±0.009）μg/L]相比,术后1 h气腹组S-100β[（0.114±0.012）μg/L]明显增高（P〈0.05）,而2组术后1h血清NSE[（12.093±0.697,13.720±1.330）μg/L]水平差异无统计学意义（P〉0.05）.术后1h非气腹组和气腹组患者血清S-100β或NSE水平与MMSE评分呈正相关（r=0.6412,0.8126,P〈0.01）.非气腹组NSE与MMSE评分无相关（r=0.4397,P〉0.05）.而气腹组NSE与MMSE评分呈正相关（r=0.7111,P〈0.01）.结论 二氧化碳气腹可能影响妇科手术患者的术后早期认知功能MMSE评分与血清S-100β和NSE血清浓度密切相关.

Objectives To investigate the effect of carbon dioxide pneumoperitoneum on postoperative cognitive dysfunction and the level of serum NSE and S-100β protein in female patients undergoing gynecological laparoscopy. Methods 60 ASA physical status Ⅰ patients were divided two groups, group Ⅰ received no insufflation andconventional abdominal surgery （ n = 30） and group Ⅱ received abdominal insufflation and gynecological laparoscopy （ n =30）. MMSE was recorded at several different time points, including one day before operation, 1, 6, 24, 48, 72h after operation, and before discharge. Serum S-100β protein and NSE was measured by ELISA before the beginning of operation （ or carbon dioxide pneumoperitoneum） and 1h after operation （or carbon dioxide pneumoperitoneum）. Results MMSE values at 1,6,24,48,72h decreased significantly in group Ⅱ （24. 67 ± 1.47,25.97 ± 1.50,26. 77 ± 1.61,27.07 ± 1.87,27.37 ± 2. 06） after operation, compared with group Ⅰ （27.63 ± 1. 33,27.27 ± 0. 87,28.37 ± 0. 85,28.73 ±0. 78,29. 23 ±0. 86, P 〈0. 01 ）. And the baseline value （29. 17 ±0. 76） of serum S-100β[（0. 114 ±0. 012,0. 086 ±0. 009） μg/L] protein and NSE [（ 13. 720 ± 1. 330,12. 093 ±0. 697） μg/L] increased significantly at 1h after operation in group Ⅰ and Ⅱ compared with before operation [（0. 035 ±0. 030,0. 035 ±0.024;5.753±0.889,5.831 ±0.967）μg/L, P 〈0.01]. Serum S-100 β protein[（0. 114 ±0.012） μg/L] increased significantly at 1h after operation in group Ⅱ, compared with group Ⅰ [（0. 086 ±0. 009） μg/L,P 〈 0. 05], whereas NSE showed not difference [（ 12. 093 ± 0. 697,13. 720 ± 1. 330） μg/L, P 〉 0. 05].Serum of S-100β protein and MMSE were significantly correlated w group Ⅰ and Ⅱ （ r = 0. 6412,0. 8126, P 〈0.01）. Serum NSE was not correlated with the MMSE score in group Ⅰ （ r =0.4397, P 〉0.05）,whereas NSE and MMSE had significant correlation in group Ⅱ （ r = 0. 7111, P 〈0. 01 ）. Conclusions Carbon dioxide pneumoperitoneum in patients with gynecological surgery might affect postoperative cognitive function, and MMSE score was negatively correlated with serum S-100β and NSE proteins.