P_ETCO₂)水平对达芬奇老年患者脑氧及术后认知的影响

Effect of P_ETCO₂) Level on Cerebral Oxygen and Postoperative Cognition in Elderly Patients with Da Vinci

摘要: 目的：探索术中不同PETCO2水平对达芬奇机器人腹腔镜前列腺切除术和直肠根治术老年患者的脑氧代谢及术后认知的影响。方法：选取2020年6月~2021年6月青岛大学附属医院收治的择期拟行达芬奇机器人辅助腹腔镜前列腺切除术和直肠根治术的老年患者60例为研究对象。所有患者随机分成三组(n = 20)：L组(25~30 mmHg)，M组(30~45 mmHg)、H组(45~50 mmHg)。于麻醉开始前(T₀)，开放气腹(T₁)，开放气腹后30 min (T₂)，开放气腹后90 min (T₃)，关闭气腹体位恢复后(T4)记录患者心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)、中心静脉压(central venous pressure, CVP)、呼末二氧化碳分压(end-tidal carbon dioxide partial pressure, P_ETCO₂)、氧分压(oxygen partial pressure, PO₂)、颈静脉球氧饱和度(Jugular bulb venous oxygen saturation, SjvO₂)、视神经鞘直径(optic nerve sheath diameter, ONSD)。于术前1天，术后1天，3天，7天对患者作简易精神状态量表(mini-mental state examination, MMSE)评分。结果：T₂，T₃，T₄时刻Hb组间有明显差异(P均 < 0.05)；T1，T2，T3时刻组间SjvO2有明显差异(P均 < 0.05)，均为H组 > M组 > L组；T₁，T₂，T₃时刻组间ONSD有明显差异(P均 < 0.05)，且均为H组 > M组 > L组，组间有明显差异(P均 < 0.05)；术后1天三组患者MMSE评分较术前一天明显下降(P < 0.05)。结论：高水平P_ETCO₂有利于患者保持脑供需平衡、维持脑氧代谢稳定和降低患者发生术后认知功能障碍的风险。

Abstract: Objective: To explore the effects of different intraoperative P_ETCO₂ levels on cerebral oxygen metab-olism and postoperative cognition in elderly patients undergoing Da Vinci robotic laparoscopic prostatectomy and radical rectal resection. Methods: A total of 60 elderly patients who were sched-uled to receive Da Vinci robot-assisted laparoscopic prostatectomy and radical rectotomy in Affili-ated Hospital of Qingdao University from June 2020 to June 2021 were selected as subjects. All pa-tients were randomly divided into three groups (n = 20): Group L (25~30 mmHg), group M (30~45 mmHg) and group H (45~50 mmHg). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), end-tidal carbon dioxide partial pressure (P_ETCO₂), oxygen partial pressure (PO₂), Jugular bulb venous oxygen saturation (SjvO₂), and optic nerve sheath diameter (ONSD) were rec-orded before anesthesia (T₀), open pneumoperitoneum (T₁) and 30 min after opening pneumoperi-toneum (T₂), 90 min after opening pneumoperitoneum (T₃) and after the closed pneumoperitone-um position (T₄). The patients were scored on the mini-mental state examination (MMSE) 1 day be-fore surgery, 1 day, 3 days, and 7 days after surgery. Results: There were significant differences in Hb at time T₂, T₃ and T₄ (all P < 0.05). There were significant differences in SjvO₂ among groups at time T₁, T₂ and T₃ (all P < 0.05), which were group H > group M > group L. There were significant differences in ONSD among groups at T₁, T₂ and T₃ (all P < 0.05), and they were group H > group M > group L, with significant differences among groups (all P < 0.05). MMSE scores in three groups were significantly decreased 1 day after surgery compared with the 1 day before surgery (P < 0.05). Con-clusion: High level of P_ETCO₂ is beneficial to maintain the balance of brain supply and demand, maintain the stability of brain oxygen metabolism and reduce the risk of POCD in patients.