| 崔晓媛,梁仁芮,王春燕.允许性高碳酸血症对机器人辅助老年前列腺根治性切除术脑氧饱和度及术后认知功能障碍的影响[J].安徽医药,2021,25(7):1350-1354. |
| 允许性高碳酸血症对机器人辅助老年前列腺根治性切除术脑氧饱和度及术后认知功能障碍的影响 |
| Effects of permissive hypercapnia on regional cerebral oxygen saturation and postoperative cognitive dysfunction in robotic-assisted radical prostatectomy for the elderly |
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| DOI：10.3969/j.issn.1009-6469.2021.07.019 |
| 中文关键词: 前列腺切除术 机器人手术 允许性高碳酸血症 局部脑氧饱和度 术后认知功能障碍 老年人 |
| 英文关键词: Prostatectomy Robotic surgical procedures Permissible hypercapnia Regional cerebral oxygen saturation Postoperative cognitive dysfunction Elderly |
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| 中文摘要: |
| 目的探讨允许性高碳酸血症( PHC)机械通气对老年病人机器人辅助腹腔镜下前列腺根治性切除术局部脑氧饱和度(rSO2)及术后认知功能障碍( POCD)的影响。方法本研究选取 2018年 7月至 2019年 7月山西医科大学第一医院择期行机器人辅助腹腔镜下前列腺根治性切除术的病人 60例，使用随机数字表法随机分为常规通气组(R组)和允许性高碳酸血症机械通气组( H组)，每组 30例，术中通过调控呼吸参数使 R组动脉血二氧化碳分压( PaCO2)维持在 35~45 mmHg，pH维持在 7.35~ 7.45；H组 PaCO2维持在 45~55 mmHg，pH值 7.20~7.35。分别记录每组病人术前( T0)、气腹前 5 min(T1)、气腹后 20 min(T2)、气腹后 1h(T3)、气腹后 2h(T4)、气腹结束后 20 min(T5)的 PaCO2rSO2及动脉血气分析结果。所有病人分别在手术前 1d(M0)，手术后 1d(M1)4d(M2)7d(M3)时采用简易智能精神状态检查量、表( MMSE)评估认知功能。结果 R组 T2-T4时刻的 PaCO2分别为(37.65±1.48)，mmHg、(，38.36±1.99)mmHg、(39.20±1.75)mmHg，rSO2分别为( 65.79±1.88)%、(65.97±1.76)%、(65.90±1.67)%， T2-T5时刻的 pH分别为( 7.409±0.018)、(7.389±0.014)、(7.386±0.018)、(7.395±0.014)，M1时的 MMSE评分为( 24.80±1.40)分，术后认知功能障碍发生率为 38%(11/29)； H组 T2-T4时刻的 PaCO2分别为( 43.15±3.06)mmHg、(50.34±2.24)mmHg、(51.65±2.08) mmHg，rSO2分别为( 68.10±1.18)%、(70.56±1.46)%、(70.94±1.67)%，T2-T5时刻的 pH分别为( 7.369±0.012)、(7.307±0.032)、(7.299±0.029)、(7.363±0.01)，M1时的 MMSE评分为( 26.40±1.51)分，术后认知功能障碍发生率为 13%(4/30)。与 T0时刻相比， H组 T2-T5时刻的 PaCO2、rSO2升高， pH降低( P<0.05)；与 M0相比，两组 M1时的 MMSE评分均降低( P<0.05)。与 R组相比， H组 T2-T4时刻的 PaCO2rSO2升高， T2-T5时刻的 pH降低， M1时的 MMSE评分升高，术后认知功能障碍发生率降低，均差异有统计学意义( P<0.05)。结论、术中采用允许性高碳酸血症机械通气可提高老年病人机器人辅助腹腔镜下前列腺根治性切除术术中 rSO2，从而减轻术后早期认知功能障碍。 |
| 英文摘要: |
| Objective To investigate the effects of permissive hypercapnia (PHC) mechanical ventilation on regional cerebral oxygen saturation (rSO2) and postoperative cognitive dysfunction (POCD) in elderly patients undergoing robotic-assisted laparoscopic radical prostatectomy.Methods In this study, 60 patients who underwent robot-assisted laparoscopic radical prostatectomy in the First Hospitalof Shanxi Medical University from July 2018 to July 2019 were randomly divided into conventional ventilation group (R group) and permissible hypercapnea mechanical ventilation group (H group) using random number table method, with 30 patients in each group. The arterial partial pressure of carbon dioxide (PaCO2) in group R was maintained at 35-45 mmHg and the pH value was 7.35-7.45 by adjusting the respiratory parameters during the operation, and PaCO2 in H group was maintained at 45-55 mmHg and pH value 7.20-7.35. The results of PaCO2, rSO2 and arterial blood gas analysis were recorded before operation (T0), 5 minutes before pneumoperitoneum (T1), 20 minutes after pneumoperitoneum (T2), 1 hour after pneumoperitoneum (T3), 2 hours after pneumoperitoneum (T4), and 20 minutes after the end of pneumoperitoneum (T5). All patients were assessed with the Mini-mental State Examination (MMSE) at 1 day before operation (M0), and 1 day (M1), 3 days (M2) and 7 days (M3) after operation, respectively.Results PaCO2 of group R at T2-T4 was (37.65±1.48) mmHg, (38.36± 1.99) mmHg, (39.20±1.75) mmHg, rSO2 was (65.79±1.88) %, (65.97±1.76) %, and (65.90±1.67) %, respectively. The pH values at T2-T5 was (7.409±0.018), (7.389±0.014), (7.386±0.018), and (7.395±0.014), respectively. The MMSE score at M1 was (24.80±1.40), and the incidence of postoperative cognitive dysfunction was 38% (11/29). PaCO2 of group H at T2-T4was (43.15±3.06) mmHg, (50.34±2.24) mmHg, (51.65±2.08) mmHg, rSO2 was (68.10±1.18) %, (70.56±1.46) %, and (70.94±1.67) %, respectively. The pH values at T2-T5 was (7.369± 0.012), (7.307±0.032), (7.299±0.029), and (7.363±0.01), respectively. The MMSE score at M1 was (26.40±1.51), and the incidence of postoperative cognitive dysfunction was 13% (4/30). Compared with the time at T0, PaCO2 and rSO2increased and pH value decreased in group H at the time of T2-T5, and the difference was statistically significant (P < 0.05); and MMSE score at M1decreased in both groups compared with M0, and the difference was statistically significant (P < 0.05). Compared with group R, group H had higher PaCO2 and rSO2 at T2-T4, lower pH at T2-T5, higher MMSE score at M1 and lower incidence of postoperative cognitive dysfunction, and the differences were all statistically significant (P < 0.05).Conclusion Permissive hypercapnia mechanical ventilation during operation can improve rSO2 in robotic laparoscopic radical prostatectomy in elderly patients, thus alleviating early cognitive impairment after operation. |
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