机器人辅助前列腺癌根治术中气腹及Trendelenburg体位对老年患者脑血液回流的影响

Effects of carbon dioxide pneumoperitoneum and steep Trendelenburg positioning on cerebral blood backflow during robotic radical prostatectomy

目的：观察机器人辅助腹腔镜前列腺癌根治术中二氧化碳气腹及Trendelenburg体位对老年患者脑氧饱和度及脑血液回流的影响。方法择期行机器人腹腔镜下前列腺癌根治术的患者100例，以年龄分组，老年组：65~80岁；中年组：45~64岁，每组50例。全麻插管后，分别于气腹前（T0）、气腹后10 min（T1）、Trendelenberg体位后10 min（T2）、Trendelenberg体位后60 min（T3）、停气腹平卧后10 min（T4）抽取颈静脉球和桡动脉血进行血气分析。观察记录指标：（1）脑氧饱和度；（2）颈静脉球氧饱和度；（3）颈静脉球压力；（4）脑动静脉氧含量差；（5）颈内静脉血糖和乳酸的变化。结果与气腹前（T0）比较，两组患者在T1~T4各时刻脑氧饱和度、颈静脉球氧饱和度、颈静脉球压力升高，差异有统计学意义（P0.05）。结论二氧化碳气腹及Trendelenburg体位使老年患者脑血流增加更加明显，但并不引起脑氧代谢改变。

Objective To observe the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on cerebral blood backflow during robot-assisted radical prostatectomy in elderly patients. Methods Fifty elderly patients （65-80 years） and 50 middle-aged patients （45-64 years） undergoing elective robot-assisted prostatectomy were enrolled in this study. For all the patients, jugular bulb and arterial blood gas was monitored and recorded before pneumoperitoneum （T0）, 10 min after pneumoperitoneum was achieved （T1）, 10 min （T2） and 60 min （T3） after Trendelenberg position, and 10 min in supine position after termination of pneumoperitoneum （T4）. Results Compared with those at T0, the mean arterial pressure, heart rate, and BIS value at T1, T2, T3 and T4 all showed no significant variations （P〉0.05）, but rSO2, SjvO2, and JBP increased significantly in both groups （P0.05）. Conclusion Pneumoperitoneum and Trendelenburg position cause more obvious cerebral blood backflow in elderly patients than in middle-aged patients but do not affect cerebral metabolism of oxygen.