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

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。

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

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.