不同呼吸频率设置对腹腔镜前列腺癌根治术患者术后认知功能的影响

目的 探讨不同呼吸参数设置对腹腔镜前列腺癌根治术患者术后认知功能的影响. 方法 采用前瞻性、双盲、随机对照研究设计.择期行腹腔镜下前列腺癌根治术患者100例,年龄65 ～75岁,按随机数字表法分为5组(每组20例):A组、B组、C组、D组、E组;A组分钟通气量(minute volume,MV) 100 ml/kg,呼吸频率(respiratory rate,RR)8次/min;B组MV 100 ml/kg,RR 10次/min;C组MV 100 ml/kg,RR 12次/min;D组MV 100 ml/kg,RR 14次/min;E组MV 100 ml/kg,RR 16次/min.分别于麻醉气腹前(Ta)、放气即刻(Tb)测患者动脉血二氧化碳分压(arterial blood partial pressure of carbon dioxide,PaCO2),于术前1 d(T0)、术后1 h(T1)、术后6 h(T2)、术后24 h(T3)时测血清S100β蛋白含量,并于T0、T2、T3、术后48 h(T4)、术后72 h(T5)、术后7 d(T6)时应用简易智能精神状态检查量表(mini-mental state examination,MMSE)评估认知功能. 结果 D组患者Th时PaCO2为(42.8±3.2) mmHg(1 mmHg=0.133 kPa),明显低于其余4组(P＜0.05);D组T2、T3时血清S100β蛋白分别为(330±25)、(300±26) mg/L,明显低于其余4组(P＜0.05);D组T2、T3时MMSE评分分别为(26.90±0.60)、(27.80±0.62)分,明显高于其余4组(P＜0.05). 结论 术中呼吸参数设置为MV 100 ml/kg、RR 14次/min时较为合理,可减轻腹腔镜前列腺癌根治术患者术后早期认知功能障碍.

The influence of different setting of respiratory parameters during operation on the postoperative cognitive function after laparoscopic radical prostatectomy

Objective To investigate the influence of different respiratory parameter settingduring laparoscopic radical prostatectomy on early postoperative cognitive function.Methods One hundred patients aged 65-75 years undergoing laparoscopic radical prostatectomy were randomly divided into 5 groups (n=20):group A,B,C,D and E.All patients were ventilated with identical minute volume (MV) 100 ml/kg though with respective respiratory rate (RR) of 8,10,12,14 and 16 bpm respectively.Patients in five groups were all graded by the mini-mental state examination(MMSE) at time points of 1 day before operation(T0),postoperative 6 h(T1) postoperative 6 h (T2),24 h (T3),48 h (T4),72 h (T5),7 d (T6).The serum S100β concentation was detected at T0,T1,T2 and T3.Partial pressure of carbon dioxide(PaCO2) in arterial blood was tested before pneumoperitonen(Ta) and immediately after pneumoperitoneum (Tb).Results PaCO2 in group D at Tb (42.8±3.2) mmHg(1 mmHg=0.133 kPa) was lower than the other groups(P＜0.05).The MMSE scores in group D at T2-T3 (26.90±0.60,27.80±0.62),were remarkably higher than those in other groups (P＜0.05).The serum S100β protein concentrations in each group at T2-T3 were significantly higher than that at T0 (P＜0.05).The serum S100β protein concentrations in group D at T2 and T3 [(330±25) mg/L and (300±26) mg/L],were dramatically lower than that in other groups(P＜0.05).Conclusions Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly during laparoscopic radical prostatectomy.The respiratory parameter of MV 100 ml/kg combined with RR 14 bpm may be more reasonable for this type of surgery.