术中静脉使用小剂量甘露醇对颅内压升高的老年腹腔镜手术患者术后认知功能的影响

Effect of Intravenous Injection of Low-dosage Mannitol during Operation on Postoperative Cognitive Function in Elderly Patients with Increased Intracranial Pressure Undergoing Laparoscopic Surgery

目的研究颅内压升高的老年胃肠道肿瘤患者行腹腔镜手术过程中采用小剂量甘露醇治疗,对术后认知功能的影响。方法选取2015年6月—2017年6月在南充市中心医院进行腹腔镜手术且术中出现颅内压升高的老年胃肠道肿瘤患者60例,根据治疗方法的不同分为观察组和对照组,每组30例。2组均进行常规腹腔镜手术治疗,建立气腹后立即行特伦德伦伯卧位,当发现患者颅内压(ICP)升高≥200 mm H2O时,观察组立即给予20%甘露醇(125 ml)静脉滴注,对照组使用同等体积4℃生理盐水静脉滴注,观察并记录2组丙泊酚用量、拔管时间及术后苏醒时间;比较2组平均动脉压(MAP)、心率(HR)、二氧化碳终末潮气压(PETCO2)和血氧饱和度(Sp O2)指标;比较2组简易智能量表(MMSE)评分、颅内压下降水平及不良反应发生率。结果观察组丙泊酚用量、拔管时间及术后苏醒时间均少于或短于对照组(P<0.05);2组T0时的MAP、HR、PETCO2和Sp O2比较差异无统计学意义(P>0.05),T1时,观察组MAP水平与T0时相比明显上升,其余3项指标则明显降低,对照组Sp O2与T0时相比明显降低,其余3项指标则明显上升(P<0.05);T2-T5时,观察组MAP、HR、PETCO2小于对照组(P<0.05),Sp O2较对照组比较差异无统计学意义(P>0.05)。术后2组MMSE评分均较治疗前下降,观察组MMSE评分高于对照组(P<0.05)。观察组不良反应总发生率低于对照组(P<0.05),术后降颅内压效果优于对照组(P<0.05)。结论在对颅内压升高的老年胃肠道肿瘤患者进行腹腔镜手术的过程中,使用小剂量甘露醇进行静脉滴注能够显著改善麻醉效果,降低应激反应,控制颅内压,减少不良反应的发生,并改善术后认知功能。

Objective To investigate effect of intraoperative low-dosage Mannitol on postoperative cognitive function in elderly patients with gastrointestinal neoplasms and increased intracranial pressure （ICP） undergoing laparo- scopic surgery. Methods A total of 60 elderly patients with increased intracranial pressure undergoing laparoscopic sur- gery admitted during June 2015 and June 2017 were divided into observation group （n 30） and control group （n= 30） according to different treatment methods. All patients received routine laparoscopic operation. When increased ICP was equal or more than 200 lnlnH2 O, observation group was treated with intravenous injection of 20% Mannitol （ 125 lnl）, while control group was given intravenous injection of 4℃ physiological saline with the same volume. In two groups, Propofal dosage, extubstion time and postoperative palinesthesia time were observed; mean arterial pressure （MAP）, heart rate （HR） , end-tidal carbon dioxide partial pressure （PETCO2 ） and arterial oxygen saturation （ SpO2 ） indexes were compared; lnini-lnental state examination （MMSE） scores, decreased ICP level and incidence rate of adverse reac- tion were also compared. Results Values of Propofol dosage, extubstion time and postoperative palinesthesia time in ob- servstion group were shorter than those in control group （P 〈 0. 05）. There were no significant differences in MAP, HR, PETCO2 and SpO2 levels at TO between two groups （P 〉0.05）. In observation group, MAP level at T1 was higher than that at TO, while HR, PETCO2 and SpO2 levels at T1 were lower than those at TO. In control group, SpO2 level at T1 was higher than that at TO, while MAP, HR and PETCO2 levels at T1 were lower than those at TO （P 〈 0.05）. At T2-T5, in observation group, levels of MAP, HR and PETCO2 were lower than those in control group （P 〈0.05）, but the differ-ences in SpO2 levels between two groups showed no significant differences （P 〉0.05）. After surgery, MMSE scores were significantly lower than those before surgery in two groups, but the MMSE score in obsetwation group was significantly higher than that in control group （P 〈 0.05）. In obsetwation group, the total incidence rate of adverse reaction was low- er, while decreased level of intracranial pressure was significantly better than that in control group （P 〈0.05）. Conclu- sion Intravenous injection of low-dosage mannitol during operation in application of elderly patients with gastrointestinal neoplasms and increased intraeranial pressure undergoing laparoseopie surgery may improve anaesthetic effect, reduce in- cidence rate of adverse reaction and improve postoperative cognitive function.