不同呼吸参数对妇科腹腔镜手术后早期认知功能的影响

Intraoperative different setting of respiratory parameters influence the early postoperative cognitive func-tion after gynecological laparoscopic surgery

目的：评价不同呼吸参数对妇科腹腔镜手术患者术后早期认知功能的影响。方法择期行腹腔镜下卵巢癌或宫颈癌根治术患者80例,年龄30-60岁,均采用丙泊酚复合瑞芬太尼静脉全身麻醉,按照随机数字表法分为四组：A 组,VT 8 ml/kg,RR 12次/分；B、C、D 组分钟通气量（MV）均为105 ml/kg,RR 分别为12、15、18次/分。分别于术前（T0）、术后1 h（T1）、6 h（T2）、24 h （T3）、48 h（T4）、72 h（T5）进行简易精神状态量表（MMSE）评分。分别于麻醉后气腹前（Ta）、放气腹即刻（Tb）测定患者 PaCO2。结果与 Ta 时比较,Tb 时四组患者 PaCO2明显升高（P 〈0.05）。Tb时,A 组 PaCO2明显高于其余三组（P 〈0.05）,C 组明显低于其余三组（P 〈0.05）。T1-T3时 C 组MMSE 评分明显高于其余三组（P 〈0.05）,T4时 A 组明显低于其余三组（P 〈0.05）。T1-T4时 A组,T1-T3时 B、D 组,T1、T2时 C 组 MMSE 评分明显低于 T0时（P 〈0.05）。结论妇科腹腔镜手术对患者术后早期认知功能有影响,通过合理调节呼吸参数、适当增加 MV 可以降低妇科腹腔镜术后早期认知功能障碍。

Objective To investigate the influence of different respiratory parameter setting during gynecological laparoscopic surgery on early postoperative cognitive function.Methods Eighty patients undergoing elective ovarian cancer or cervical cancer were grouped randomly into groups A, B,C and D.In group A patients were ventilated with respiratory parameters of VT 8 ml/kg,RR 12 times/min.While patients in groups B,C and D with identical minute volume 105 ml/kg though with respective RR of 12,1 5 and 18 times/min respectively.Patients in four groups were all graded by the MMSE at time points of preoperation（T0 ）,postoperative 1 h（T1 ）,6 h（T2 ）,24 h（T3 ）,48 h（T4 ）, 72 h（T5 ）.PaCO2 of arterial blood gas were tested before pneumoperitoneum（Ta）and immediately af-ter pneumoperitoneum（Tb）.Results PaCO2 at Tb was higher in each group than that at Ta（P 〈0.05）.Patients in group A showed the highest PaCO2 at Tb while PaCO2 in group C were lowest. The MMSE scores in group C were significantly higher than those in other groups at T1-T3 （P 〈0.05）.The values at T4 in group A were lower （P 〈0.05）than those in other groups.Values at T1-T4 in group A were lower than that at T0 （P 〈0.05）.In groups B and D at T1-T3 MMSE scores were lower than those at T0 and patients in group C showed lower MMSE scores at T1 and T2 （P 〈0.05）.Conclusion Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly and increasing minute volume adequately in gynecological laparoscopic surgery.