呼吸末正压通气对老年腹腔镜手术麻醉患者脑氧代谢和认知功能的影响

The Cerebral Oxygen Metabolism and Cognitive Function Effect of Positive end Expiratory Pressure Anesthesia in Elderly Laparoscopic Operation

目的：探讨呼吸末正压通气（PEEP）对老年腹腔镜手术麻醉患者脑氧代谢和认知功能的影响。方法：选取本院2014年1月-2015年4月老年腹腔镜手术ASAⅠ-Ⅱ级患者100例，采用随机数字表法将患者分为两组，研究组52例，采用维持PEEP 5 cm H2O；对照组48例，PEEP 0 cm H2O。比较两组气腹前（T0）、气腹后1 h（T1）和气腹后2 h（T2）颈内静脉血氧饱和度（SjvO2）、动静脉血氧含量差值（CaO2-CjvO2）和脑氧摄取率（CERO2），比较两组手术前后认知功能（MMSE）评分的差异。结果：T0时刻，两组的SjvO2、CaO2-CjvO2值和CERO2比较差异无统计学意义（P〉0.05）；其中研究组的T1、T2时刻上述指标均明显低于对照组，两组比较差异均有统计学意义（P〈0.05）；两组患者手术前MMSE评分比较差异无统计学意义（P〉0.05），手术后1-7 d研究组MMSE评分明显高于对照组，认知功能障碍发生率明显低于对照组，两组比较差异均有统计学意义（P〈0.05）。结论：老年腹腔镜手术麻醉期间呼吸末正压通气有助于显著改善脑氧代谢平衡，降低术后认知功能障碍风险。

Objective：To investigate the cerebral oxygen metabolism and cognitive function effect of positive end expiratory pressure anesthesia in elderly laparoscopic operation.Method：100 laparoscopic operation in elderly ASA I-II patients in our hospital were selected from 2014 January to 2015 April and randomly divided into two groups, study group of 52 cases,they were given PEEP 5 cm H2O;control group of 48 cases,they were given PEEP 0 cmH2O. The SjvO2,CaO2-CjvO2 and CERO2 in pre-pneumoperitoneum （T0）,1 h post-pneumoperitoneum （T1） and 2 h post-pneumoperitoneum （T2） of two groups were compared,the cognitive function （MMSE score） pre-operation and post-operation of two groups were compared.Result：At T0, two groups had no statistically significant difference in SjvO2, CaO2-CjvO2 value and CERO2（P〉0.05）;the above indexes at T1,T2 of study group were significantly lower than that control group the differences were statistically significant（P〈0.05）.At pre-operative ,the MMSE score of two groups had no statistically significant difference（P〉0.05）;after 1-7 d operation,MMSE score of study group was significantly higher than that control group, the cognitive dysfunction incidence rate was significantly lower than that control group, the difference was statistically significant（P〈0.05）.Conclusion：Positive end expiratory pressure helps to significantly improve cerebral oxygen metabolism balance during anesthesia in elderly laparoscopic operation, it can reduce the risk of postoperative cognitive dysfunction.