二氧化碳气腹对妇科子宫肌瘤腹腔镜手术患者术后早期认知功能的影响

Effect of CO_2 Pneumoperitoneum on Early Cognitive Function in Patients with Gynecological Uterine Leiomyoma after Laparoscopic Surgery

目的:探讨不同气压二氧化碳气腹对子宫肌瘤腹腔镜手术患者术后早期认知功能的影响。方法:收集2015年1月至2015年12月入院的99例子宫肌瘤腹腔镜手术患者随机分为三组,L组患者给予低气压水平CO_2气腹,M组患者给予中气压水平CO_2气腹,H组患者给予高气压水平CO_2气腹,比较三组患者临床观测指标、神经化学标志物与认知功能。结果:H组患者T2与T3 Pa CO_2水平与T1、T2与T3 COR水平显著性高于L组与M组;M组患者T2与T3 PaCO_2水平与T1、T2与T3 COR水平显著性高于L组;H组与M组患者T5 Pa O2水平显著性低于L组;T2、T3与T4 NE水平显著性高于L组;T1、T2、T3与T4 PGE2水平显著性高于L组;H组患者T1与T2 NSE水平显著性高于L组与M组,S100β水平显著性高于L组;M组患者T1与T2 NSE水平显著性高于L组,存在显著性差异(P<0.05)。结论:不同气压CO_2气腹对子宫肌瘤腹腔镜手术患者术后早期认知功能影响不大,但低气压CO_2气腹可明显减轻机体应激,减少神经化学标志物的释放。

Objective： To investigate the effect of CO2 pneumoperitoneum at different pressures on early postoperative cognitive function in patients undergoing laparoscopic surgery for uterine fibroids.Methods： 99 patients with uterine leiomyoma were enrolled from January 2015 to December 2015 were randomly divided into three groups.Group L was given low-pressure CO2 pneumoperitoneum.The patients of group M were given an intermediate pressure level of CO2 pneumoperitoneum.The patients of group H were given high pressure level of CO2 pneumoperitoneum.The three groups of patients with clinical observation,neurochemical markers and cognitive function were compared.Results： T2 and T3 PaCO2 levels and T1,T2 and T3 COR of group H were significantly higher than those in group L and group M; T2 and T3 Pa CO2 levels and T1,T2 and T3 COR of group M were significantly higher than those in group L; T5 Pa O2 level in patients with group H and group M was significantly lower than that in group L; T2,T3 and T4 NE the level was significantly higher than that of group L,T2,T1; T3 and T4 PGE2 were significantly higher than those in group L; group H of T1 patients with T2 NSE were significantly higher than those in group L and group M.S100β levels significantly higher than that in group L; T1 and T2 NSE of group M were significantly higher than those in group L,there was significant difference（ P〈0.05）.Conclusion： Different air pressure pneumoperitoneum has little effect on the early cognitive function of patients with uterine leiomyoma after laparoscopic surgery,but low pressure CO2 pneumoperitoneum can relieve the body stress and reduce the release of neurochemical markers.