浅谈高海拔地区行腹腔镜手术患者围术期神经认知障碍的影响因素

A Brief Talk on the Influencing Factors of Perioperative Neurocognitive Disorders in Patients Undergoing Laparoscopic Surgery in High Altitude Area

摘要: 随着手术麻醉的普及和医学人文的发展，围术期神经认知障碍(perioperative neurocognitive disorders, PND)受到越来越多的关注。PND不仅严重影响患者生活质量导致住院时间延长，还会对家庭以及社会造成巨大负担。早期识别高危患者，提前干预，防治PND促进患者术后康复、加快医院周转，既维护了患者和医院的双方利益，也节约了公共卫生资源，减轻了国家经济负担。我国地域辽阔，很多1500米以上高海拔地区有常住人口居住。而高海拔地区的低压低氧环境可能通过影响肠道菌群、血脂代谢、睡眠等多方面增加PND的发生率。加速康复外科的兴起促使腹腔镜微创手术广泛开展。然而，在腹腔镜手术中长时间使用二氧化碳(carbon dioxide, CO₂)气腹或高CO₂气腹压力可引起皮下气肿、高碳酸血症等并发症，部分患者发生PND导致住院时间延长，甚至增加死亡风险。故本文就高海拔环境、患者自身、腹腔镜手术CO₂气腹及麻醉对PND的影响予以综述，旨在为临床医生及早识别相关高危患者，早期进行干预，降低高海拔地区行腹腔镜手术患者PND发生率提供一定理论基础。

Abstract: With the popularization of surgical anesthesia and the development of medical humanities, perioperative neurocognitive disorders (PND) have received more and more attention. PND not only seriously affects the quality of life of patients and prolongs the length of stay in hospital, but also imposes a huge burden on the family and society. Early identification of high-risk patients, early intervention, prevention and treatment of PND, promote postoperative recovery of patients, and speed up hospital turnover, which not only safeguards the interests of both patients and hospitals, but also saves public health resources and reduces the national economic burden. China has a vast territory, and many high-altitude areas above 1500 meters have permanent residents. The low-pressure and low-oxygen environment in high-altitude areas may increase the incidence of PND by affecting intestinal flora, blood lipid metabolism, sleep and other aspects. The rise of accelerated rehabilitation surgery has prompted widespread laparoscopic minimally invasive surgery. However, long-term use of carbon dioxide (CO₂) pneumoperitoneum or high CO₂ pneumoperitoneum pressure during laparoscopic surgery can cause complications such as subcutaneous emphysema and hypercapnia. PND in some patients leads to prolonged hospital stays and even death risk. Therefore, this article reviews the effects of high-altitude environment, patients themselves, laparoscopic CO₂ pneumoperitoneum and anesthesia on PND, in order to provide a certain theoretical basis for clinicians to identify related high-risk patients early and carry out early intervention to reduce the incidence of PND in patients undergoing laparoscopic surgery at high altitude.