气腹因素对腹腔镜结直肠癌根治术老年患者麻醉恢复期神经认知紊乱的影响

Effect of pneumoperitoneum factor on neurocognitive disorder during anesthetic recovery in elderly patients undergoing laparoscopic radical resection of colorectal cancer

目的评价气腹因素对腹腔镜结直肠癌根治术老年患者麻醉恢复期神经认知紊乱(ND)的影响。方法选取2019年3月至2020年12月四川省泸州市中医医院收治的行结直肠癌根治术的老年患者80例,依照不同手术方式分为腹腔镜组(L组)和开腹组(C组),每组40例。两组患者均在全身麻醉下完成手术,术毕送麻醉恢复室。记录两组患者手术时间、麻醉时间、麻醉苏醒时间,以及术前(T0)、苏醒时(T1)、苏醒1 h(T2)、出麻醉恢复室(T3)时收缩压(SBP)、舒张压(DBP)、心率、脉搏血氧饱和度的变化。采用蒙特利尔认知评估量表(MoCA)评估两组患者T0、T1、T3时认知功能,记录ND发生情况。采集两组患者T0、T1、T3时动脉血1 mL,采用干式快速诊断法进行血气分析。采集两组患者T0、T3、术后72 h(T4)时外周静脉血3 mL,采用酶联免疫吸附法测定中枢神经特异性蛋白——S100β和神经元特异性烯醇化酶(NSE)水平。结果两组患者性别、年龄、体重指数、美国麻醉医师协会分级等一般资料,以及手术时间、麻醉时间、苏醒时间比较,差异均无统计学意义(P>0.05)。两组患者不同时间点SBP、DBP、心率比较,差异均有统计学意义(P<0.05)。与T0时比较,两组患者T1时SBP、DBP、心率均升高,差异均有统计学意义(P<0.05)。L组患者T1时MoCA评分低于C组,麻醉恢复期ND发生率高于C组,差异均有统计学意义(P<0.05)。与T0时比较,L组T1时pH值降低,动脉血二氧化碳分压(PaCO_(2))升高,C组患者T1时pH值升高,PaCO_(2)降低,差异均有统计学意义(P<0.05)。与C组比较,L组患者T1时pH值降低,PaCO_(2)升高,差异均有统计学意义(P<0.05)。与T0时比较,L组患者T3时血清S100β、NSE水平增加,差异均有统计学意义(P<0.05);与C组比较,L组患者T3时血清S100β、NSE水平增加,差异均有统计学意义(P<0.05)。结论气腹因素可导致腹腔结直肠癌根治术老年患者麻醉恢复期ND。

Objective To evaluate the influence of pneumoperitoneum factor on neurocognitive disorder(ND)during anesthesia recovery period in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods Eighty elderly patients with colorectal cancer radical surgery in Luzhou Municipal Hospital of Traditional Chinese Medicine of Sichuan Province from March 2019 to December 2020 were selected and divided into the laparoscopic group(group L)and laparotomy group(group C)according to different operation modes,40 cases in each group.All patients were operated under general anesthesia and were sent to the anesthesia recovery room after operation.The operation time,anesthesia time and recovery time were recorded in the two groups.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and SpO_(2) of the two groups were recorded before operation(T0),when awake(T1),at 1 h after awakening(T2)and when leaving the anesthesia recovery room(T3).The cognitive function of the patients at T0,T1 and T3 was assessed with the Montreal Cognitive Assessment Scale(MoCA),and the occurrence of ND was recorded.Arterial blood 1mL was collected at T0,T1 and T3 respectively,and blood gas was analyzed by dry rapid diagnosis method.3 mL of peripheral venous blood was collected at T0,T3 and 72 h after operation(T4).The levels of central nerve specific protein(S100β)and neuron specific enolase(NSE)were determined by enzyme-linked immunosorbent assay(ELISA).Results There were no statistically significant differences in the sex,age,body mass index,American Society of Anesthesiology grading,operation time,anesthesia time and recovery time between the two groups(P>0.05).There were statistical differences in SBP,DBP and HR at different time points between the two groups(P<0.05).Compared with at T0,SBP,DBP and HR at T1 in the two groups were significantly increased(P<0.05).The MoCA score at T1 in the group L was significantly lower than that in the group C,and the incidence rate of ND during the anesthetic recovery period in the group L was significantly higher than that in the group C,and the differences were statistically significant(P<0.01).Compared with at T0,the pH value at T1 in the group L was significantly decreased and PaCO_(2) was significantly increased(P<0.01),the pH value at T1 in the group C was increased and PaCO_(2) was significantly decreased,and the differences were statistically significant(P<0.01).Compared with the group C,the PH value at T1 in the group L was significantly decreased and PaCO_(2) was significantly increased,and the differences were statistically signiifcant(P<0.01).Compared with at T0,the serum S100βand NSE levels at T3 in the group L was significantly increased,and the difference was statistically significant(P<0.01);compared with the group C,the serum S100βand NSE levels at T3 in the group L were significantly increased,and the differences were statistically significant(P<0.01).Conclusion The pneumoperitoneum factor can lead to ND during anesthesia recovery period in elderly patients with colorectal cancer radical surgery.