后腹腔镜下CO2气腹对老年患者脑氧饱和度及S-100β蛋白的影响

Impacts of CO2 pneumoperitoneum on cerebral oxygen saturation and S-100βprotein in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy

目的探讨后腹腔镜手术下CO2气腹对老年患者局部脑氧饱和度(rScO2)及S-100β蛋白的影响。方法纳入2018年5月至2019年3月择期行后腹腔镜下根治性肾切除术的老年患者55例。术中气腹压为15 mm Hg,通过应用FORE-SIGHT近红外无创脑氧检测仪监测rScO2。分别记录:T0(入室即刻)、T1(气腹前5 min)、T2(CO2气腹后10 min)、T3(CO2气腹后30 min)、T4(CO2气腹后60 min)、T5(关闭CO2气腹后10 min)各时点即刻的脉搏氧饱和度(SpO2)、心率(HR)、脑血氧饱和度(rScO2)和平均动脉压(MAP)。检测并记录T0~T5即刻的血气pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血红蛋白(Hb)等数据;检测T0与T4即刻的颈内静脉血浆S-100β蛋白水平。结果S-100β蛋白、rScO2、PaCO2、pH和PaO2在T0至T56个时相间差异均有统计学意义(P均<0.01),MAP、HR、SpO2和Hb在T0至T56个时相间差异均无统计学意义(P均>0.05)。两两时相间差异显示,与T0比较,T4~T5时的rScO2明显增高,T4时的S-100β蛋白水平明显增高;与T0~T1相比,T3~T5时的pH明显降低,T2~T5的PaCO2明显增高,差异均有统计学意义(P均<0.05)。结论后腹腔镜下CO2气腹可使老年患者rScO2明显增高;且颈内静脉血S-100β蛋白水平及动脉血PaCO2随CO2气腹时间的延长而逐渐增高。

Objective To investigate the influences of CO2 pneumoperitoneum on regional cerebral oxygen saturation(rScO2)and S-100β protein in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.Methods Fifty-five elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy from May 2018 to March 2019 were included,whose rScO2 was monitored by FORE-SIGHT non-invasive near-infrared spectroscopy.The intraoperative pneumoperitoneum pressure was 15 mm Hg.Pulse oxygen saturation(SpO2),heart rate(HR),rScO2 and mean artery pressure(MAP) were recorded respectively at each time point of entering operating room(T0),5 min before CO2 pneumoperitoneum(T1),10 min after CO2 pneumoperitoneum(T2),30 min after CO2 pneumoperitoneum(T3),60 min after CO2 pneumoperitoneum(T4),10 min after CO2 pneumopeeritoneum(T5).Immediate blood gas analysis(pH) PaO2,PaCO2,hemoglobin(Hb)and other data at T0-T5 were detected and recorded.At T0-T4,S-100β protein levels in plasma of internal jugular vein were determined immediately.Results There were significant differences in S-100 β protein,rScO2,PaCO2,pH and PaO2 at T0 to T5(all P<0.01),but no significant differences in MAP,HR,SpO2 and Hb at these time points(all P>0.05).Compared with T0,rScO2 significantly increased at T4-T5,and S-100β protein level increased at T4;compared with T0-T1,pH value significantly decreased at T3-T5,and PaCO2 increased statistically at T2-T5(all P<0.05).Conclusion In the elderly patients receiving retroperitoneal laparoscopic radical nephrectomy,CO2 pneumoperitoneum significantly increase rScO2,and the levels of S-100β protein in cervical venous blood and PaCO2 also increase gradually with the prolongation of CO2 pneumoperitoneum.