二氧化碳气腹对新生儿脑功能的影响

Effect of carbon dioxide pneumoperitoneum on neonatal brain function

目的分析CO_2气腹对新生儿脑组织功能的影响,为腹腔镜术在新生儿治疗中的安全应用提供依据。方法选取2016年1月~2017年6月在我院因十二指肠梗阻行腹腔镜手术的36例新生儿作为腹腔镜组,同期选取20例因十二指肠梗阻行常规手术治疗的新生儿作为对照组。测定腹腔镜组患儿气腹前15 min(T_0)、气腹后15 min(T_1)、气腹后45 min(T_2)及气腹结束15 min(T_3)的各项脑功能指标。并比较两组新生儿的新生儿神经行为测定(NBNA)评分。结果腹腔镜组患儿气腹后T_1、T_2点血清糖分解烯醇酶(NSE)与神经生化标志物(S100β)蛋白浓度高于T_0时水平,差异有统计学意义(P<0.05);解除气腹T_3时NSE和S100β蛋白浓度较气腹时降低,但仍高于气腹前水平,差异均有统计学意义(P<0.05)。两组患儿NBNA评分比较,差异无统计学意义(P>0.05)。结论人工CO_2气腹对新生儿血清NSE、S100β蛋白水平有可逆性的影响,但对新生儿神经行为无明显影响。

Objective To analyze the effect of carbon dioxide pneumoperitoneum on neonatal brain tissue function and provide basis for the safe application of laparoscopy in neonatal treatment.Methods A total of 36 neonates undergoing laparoscopic surgery for duodenal ileus in our hospital from January 2016 to June 2017 were selected as laparoscopic group.During the same period,another group of 20 patients undergoing routine surgical treatment for duodenal obstruction were selected as control gorup.The brain function parameters of children in the laparoscopic group were determined 15 min before pneumoperitoneum（T0）,15 min after pneumoperitoneum（T1）,45 min after pneumoperitoneum（T2）,and 15 min after the end of pneumoperitoneum（T3）.The neonatal behavioral neurological assessment（NBNA） scores were compared between the two groups.Results The levels of serum neuron-specific enolase（NSE） and S100β protein at the T1 and T2 in the laparoscopic group were significantly higher than those at the T0（P〈0.05）.The concentrations of NSE and S100β protein at the T3 were lower than those during the pneumoperitoneum,but still higher than those before pneumoperitoneum,which were displayed statistical differences（P〈0.05）.There was no significant difference in NBNA scores between the two groups（P〉0.05）.Conclusion Artificial CO2 pneumoperitoneum has reversible effect on serum levels of NSE and S100β in neonates,but no significant effect on neonatal neurological behavior.