CO_2气腹不同压力对腹腔镜下胆囊切除术患者术后早期认知功能的影响

Effect of CO_2 pneumoperitoneum on early postoperative cognitive function in patients undergoing laparoscopic cholecystectomy

目的探讨CO_2气腹不同压力对腹腔镜下胆囊切除术患者术后早期认知功能的影响。方法选取择期拟行腹腔镜下胆囊切除术的60例胆囊结石患者,随机分为低压组与标准压组,每组30例,术中相同麻醉用药,低压组CO_2气腹压力维持在1.3~1.4 k Pa,标准压组CO_2气腹压力维持在1.5~1.6 k Pa,观察两组患者术前及术后12 h时简易精神状态量表(MMSE)评分变化及术后1 d时血清神经元特异烯醇化酶(NSE)及S100β变化。结果低压组术前、术后12 h时MMSE评分为(28.93±0.34)分、(26.83±0.94)分,标准压组为(28.86±0.31)分、(26.21±0.78)分,两组术后12 h时MMSE评分低于术前(P<0.05),标准压组低于低压组(P<0.05);低压组术前及术后1 d时血清NSE分别为(6.19±1.10)ng/ml、(11.42±1.32)ng/ml,S100β分别为(0.20±0.03)ng/ml、(0.43±0.06)ng/ml,标准压组血清NSE分别为(6.21±1.05)ng/ml、(14.95±1.45)ng/ml,S100β分别为(0.19±0.03)ng/ml、(0.64±0.09)ng/ml,两组术后1 d时血清NSE及S100β高于术前(P<0.05),标准压组高于低压组(P<0.05)。结论腹腔镜下胆囊切除术时CO_2气腹压力较低可有助于减少血清NSE及S100β的释放,对患者术后认知功能影响相对较小。

Objective To investigate the effect of CO2 pneumoperitoneum on early postoperative cognitive function in patients undergoing laparoscopic cholecystectomy.Methods 60 cases of gallstone patients undergoing laparoscopic cholecystectomy,were randomly divided into low pressure group and standard group,30 cases in each group,with the same anesthesia group,low pressure CO2 pneumoperitoneum pressure maintained at 1.3-1.4 kPa standard pressure group CO2 pneumoperitoneum pressure was maintained at 1.5-1.6 kPa,mini mental state scale observed the two groups before and after 12 h(MMSE)and postoperative 1day score changes of serum neuron specific enolase(NSE)and S100βchange.Results The preoperative and postoperative 12 h MMSE score was(28.93±0.34),(26.83±0.94),standard pressure group(28.86±0.31),(26.21±0.78),two groups of postoperative 12 h MMSE score lower than that before operation(P<0.05),the standard pressure group was lower than that of low pressure group(P<0.05);low preoperative and postoperative serum 1day NSE were(6.19±1.10)ng/ml,(11.42±1.32)ng/ml,S100βrespectively(0.20±0.03)ng/ml,(0.43±0.06)ng/ml standard pressure serum NSE were(6.21±1.05)ng/ml and(14.95±1.45)ng/ml,S100βrespectively(0.19±0.03)ng/ml,(0.64±0.09)ng/ml,two groups of serum NSE and beta 1 day S100βhigher than that before operation(P<0.05),the standard pressure group was higher than that in low pressure group(P<0.05).Conclusion Laparoscopic cholecystectomy has lower CO2 pneumoperitoneum pressure,which can reduce the release of serum NSE and S100β,and has relatively little effect on postoperative cognitive function.