允许性高碳酸血症机械通气对腹腔镜手术老年轻度慢阻肺患者脑组织氧合及术后认知功能的影响

Effect of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with chronic obstructive pulmonary disease by laparoscopic surgery

目的探讨允许性高碳酸血症机械通气对腹腔镜下老年轻度慢阻肺患者脑组织氧合代谢及术后认知功能的影响。方法择期全麻下腹腔镜手术的老年轻度慢阻肺患者60例,分为常规通气组(N组)和允许性高碳酸血症机械通气组(H组)。气管插管后10 min(T_0)、气腹后50 min(T_1)、气腹后100 min(T_2)、放气后10 min(T_3)时采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO_2)和脑氧摄取率(CERO_2),监测脑氧饱和度(rSO_2)。术前1 d及术后1、3 d时采用蒙特利尔认知评估量表(MoCA)评价术后认知功能。结果与N组相比,H组p(CO_2)和rSO_2升高,pH值、Da-jvO_2和CERO_2降低,术后MoCA评分升高,术后认知功能障碍发生率显著降低(P<0.05);与T0时相比,H组T_1~T_3时p(CO_2)、rSO_2升高,p H值、Da-jvO_2和CERO_2降低;2组T_1~T_3时Da-jvO_2和CERO_2降低,rSO_2升高,术后1~3 d的MoCA评分显著降低(P<0.05)。结论允许性高碳酸血症机械通气可改善老年轻度慢阻肺患者术中脑组织氧合代谢,减轻术后认知功能障碍。

Objective To investigate effects of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in laparoscopy in elderly patients with mild COPD.Methods Sixty elderly patients with mild obstructive pulmonary disease undergoing elective laparoscopy under general anesthesia were randomly divided into routine ventilation group（group N） and permissive hypercapnia ventilation group（group H）.Blood samples were collected to implement blood gas analysis at 10 min（T_0） after endotracheal intubation,50 min（T_1） and 100 min（T_2） after pneumoperitoneum,and 10 min after exhaust（T_3）.Blood oxygen content differences of arterial-internal jugular vein（Da-jv_2） and cerebral oxygen extraction rate（CERO_2） were calculated at the same time.Cerebral oxygen saturation（rSO_2） was monitored all the time.Cognitive function was assessed by Montreal Cognitive Assessment Scale（MoCA） at 1 d before operation,and 1 d and 3 d after operation.Results Compared with group N,p（CO2） and rSO2 were significantly increased,and p H value,Da-jvO2 and CERO_2 were significantly decreased,MoCA score was significantly increased after operation,and the incidence of post-operative cognitive dysfunction was significantly decreased after operation（P〈0.0 5）.Compared with the baseline value at T0,Da-jvO2 and CERO_2 were significantly decreased,rSO2 were significantly increased,and MoCA scores at 1 to 3 d were reduced in two groups.Compared with baseline at T0,group H had increased p（CO2）,rSO2,increased p H value,Da-jvO2 and CERO2,at T（1 ~ 3）（P〈0.05）.Conclusion Permissive hypercapnia ventilation can improve the cerebral oxygen metabolism during laparoscopic surgery,and reduce post-operative cognitive dysfunction in the elderly patients with mild chronic obstructive pulmonary disease.