| 李玲霞,高东梅,胡 彬,贺 芬,任 斐,李元军,王 敏.不同CO2气腹压力对老年腹腔镜结直肠癌根治术患者苏醒质量、应激反应和术后认知功能的影响[J].,2022,(1):177-181 |
| 不同CO2气腹压力对老年腹腔镜结直肠癌根治术患者苏醒质量、应激反应和术后认知功能的影响 |
| Effects of Different CO2 Pneumoperitoneum Pressure on Recovery Quality, Stress Response and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Radical Resection of Rectal Cancer |
| 投稿时间：2021-05-23 修订日期：2021-06-18 |
| DOI：10.13241/j.cnki.pmb.2022.01.034 |
| 中文关键词: 气腹压力 老年 腹腔镜结直肠癌根治术 苏醒质量 应激反应 认知功能 |
| 英文关键词: Pneumoperitoneum pressure Elderly Laparoscopic radical resection of rectal cancer Recovery quality Stress response Cognitive function |
| 基金项目:陕西省延安市科技计划项目（SL2019ZCSY-002，SL2019ZCSZ-003）；陕西省社会发展科技攻关项目（2016SF-075） |
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| 中文摘要: |
| 摘要 目的：观察不同二氧化碳（CO2）气腹压力对老年腹腔镜结直肠癌根治术患者苏醒质量、应激反应和术后认知功能的影响。方法：选择2018年5月~2020年12月期间我院收治的择期行腹腔镜结直肠癌根治术患者91例，按入院奇偶号顺序将患者分为低CO2气腹压力组（低压力组，10 mmHg， 45例）和高CO2气腹压力组（高压力组， 15 mmHg ，46例）。对比两组苏醒质量、应激反应、呼吸功能指标和认知功能变化情况。结果：低压力组患者的苏醒期躁动发生率低于高压力组（P<0.05）。两组患者注气针穿刺时（T1） 、气腹成功建立时（T2）、放气后10 min（T3）时间点C反应蛋白（CRP）、皮质醇均高于入室时（T0）时间点（P<0.05），低压力组T1、T2、T3时间点CRP、皮质醇均低于高压力组（P<0.05）。与气腹前相比，两组气腹20 min后动脉血氧分压（PaO2）降低，动脉血二氧化碳分压（PaCO2）升高（P<0.05），与低压力组相比，高压力组PaO2更低，PaCO2更高（P<0.05）。术后第1 d、术后第3 d、术后第7 d，低压力组简易精神状态检查量表（MMSE）评分均高于同时间点的高压力组（P<0.05）。结论：老年腹腔镜结直肠癌根治术中，采用较低的CO2气腹压力可提升苏醒质量，减轻机体应激反应、呼吸系统损害和认知功能损害。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of different carbon dioxide (CO2) pneumoperitoneum pressure on recovery quality, stress response and postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of colorectal cancer. Methods: 91 patients undergoing laparoscopic radical resection of colorectal cancer were selected from May 2018 to December 2020, they were randomly divided into low CO2 pneumoperitoneum pressure group (low pressure group, 10 mmHg, 45 cases) and high CO2 pneumoperitoneum pressure group (high pressure group, 15 mmHg, 46 cases). The recovery quality, stress response, respiratory function indexes and cognitive function of the two groups were compared. Results: The incidence of restlessness in the wake period in the low pressure group were all lower than those in the high pressure group (P<0.05). The C-reactive protein (CRP) and cortisol at the time of puncture (T1), successful establishment of pneumoperitoneum (T2) and 10 min after deflation (T3) time points were higher than those at entering the room (T0) time point (P<0.05). CRP and cortisol at T1, T2 and T3 in low pressure group were lower than those in high pressure group (P<0.05). Compared with before pneumoperitoneum, arterial partial pressure of oxygen (PaO2) decreased, and arterial partial pressure of carbon dioxide (PaCO2) increased in two groups 20 minutes after pneumoperitoneum (P<0.05). Compared with low pressure group, PaO2 was lower, and PaCO2 was higher in high pressure group (P<0.05). The mini mental state examination (MMSE) scores of the low pressure group were higher than those of the high pressure group at 1 d, 3 d and 7 d after the operation (P<0.05). Conclusion: In elderly patients undergoing laparoscopic radical resection of colorectal cancer, lower pneumoperitoneum pressure can reduce the incidence of agitation during recovery period, high incidence of PETCO2 during operation, cardiovascular medication rate, and reduce stress response, respiratory system and cognitive function damage. |
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