本文選題：人工氣腹　切入點：腹腔鏡手術(shù)　出處：《臨床麻醉學(xué)雜志》2017年02期 　論文類型：期刊論文

【摘要】：目的 研究不同壓力CO_2氣腹對婦科腹腔鏡手術(shù)患者術(shù)后早期認(rèn)知功能的影響。方法選擇擇期行婦科腹腔鏡手術(shù)患者90例,年齡40~60歲,ASAⅠ或Ⅱ級,采用隨機(jī)數(shù)字表法將患者分為三組,每組30例。L組、M組和H組氣腹壓力分別為6~8、9~11和12~14mm Hg。所有患者術(shù)前24h、術(shù)后24h和72h進(jìn)行神經(jīng)心理學(xué)測驗和問卷調(diào)查,根據(jù)評分測驗結(jié)果判斷患者術(shù)后認(rèn)知功能是否降低。于麻醉誘導(dǎo)前10min(T_1)、術(shù)畢(T_2)、術(shù)后6h(T_3)、24h(T_4)和72h(T_5)檢測靜脈血神經(jīng)元特異性烯醇化酶(NSE)和S100β蛋白含量。記錄麻醉誘導(dǎo)前(T_a)、氣腹前(T_b)、氣腹后1h(T_c)、2h(T_d)及停止氣腹后1h(Te)的動脈血pH、PaCO_2和PaO_2。結(jié)果 三組不同時點神經(jīng)心理學(xué)測試得分差異無統(tǒng)計學(xué)意義,從測試結(jié)果中未能得出各組患者術(shù)后早期認(rèn)知功能下降。T_2、T_3時L組和M組NSE含量明顯低于H組(P0.05);T_2時L組和M組S100β蛋白含量明顯低于H組(P0.05)。T_c、T_d時M組和H組pH明顯低于L組(P0.05),T_c~T_e時M組和H組PaCO_2明顯高于L組(P0.05)。結(jié)論 不同壓力二氧化碳?xì)飧箤πg(shù)后早期認(rèn)知功能未見明顯影響,但低壓力(6~8mm Hg)二氧化碳?xì)飧姑黠@減少患者術(shù)后血液中NSE及S100β蛋白的釋放。
[Abstract]:Objective to study the effect of different pressure CO_2 pneumoperitoneum on the early cognitive function of patients undergoing gynecologic laparoscopic surgery. The patients were divided into three groups by random digital table. The pneumoperitoneum pressure of group M and group H were 6 / 8 / 9 / 11 and 12 / 14 mm / h respectively. Neuropsychological tests and questionnaires were performed 24 hours before operation, 24 hours and 72 hours after operation. According to the result of score test, the cognitive function of patients after operation was determined. 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min before anesthesia induction, 10 min after anesthesia, after operation, after operation, T2P, 6 h after operation, 6 h after operation, 6 h after operation, the levels of NSEs and S100 尾 protein in venous blood were detected. The contents of NSEs and S100 尾 protein were measured before anesthesia induction. Results there was no significant difference between the three groups in the scores of Paco _ 2 and Pao _ 2 at 1 hour after pneumoperitoneum, 1 h after pneumoperitoneum and 1 h after cessation of pneumoperitoneum. From the results of the test, it can not be concluded that the levels of NSE in group L and group M are significantly lower than those in group H at the time of P0.05 and T2 after operation. The content of S100 尾 protein in group L and M is significantly lower than that in group H (P0.05N. Tctid). The pH of group M and group H is significantly lower than that of group H at day 3. The PaCO_2 of group M and group H were significantly higher than that of group L (P 0.05). Conclusion there is no significant effect on early cognitive function of patients with different pressure of carbon dioxide pneumoperitoneum. However, the release of NSE and S100 尾 protein in the blood of the patients after pneumoperitoneum was significantly reduced by hypobaric carbon dioxide pneumoperitoneum.
【作者單位】： 安徽醫(yī)科大學(xué)附屬安慶醫(yī)院麻醉科;安徽醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科;

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