【摘要】 目的观察呼气末二氧化碳分压(P_ETCO₂)对腹腔镜直肠癌根治术老年患者术后认知功能影响。方法例84行腹腔镜直肠癌根治术老年患者随机分为A、B组,P_ETCO₂分别维持在40⁴5 mm Hg和35³9 mm Hg。检测血清S100β蛋白浓度、潮气量（V_T）、气道峰压（Ppeak）、动脉二氧化碳分压（PaCO₂）、动-静脉血氧含量差、脑氧摄取率,用简易精神状态量表（MMSE）评估术后认知功能障碍（POCD）。结果 A组POCD发生率及术后6、24 h、72 h血清S100β蛋白浓度明显低于B组（P<0.01）。气腹后30、60 min,A组V_T、Ppeak、动-静脉血氧含量差和脑氧摄取率均低于B组,而PaCO₂高于B组（P<0.05）。结论40⁴5 mm Hg P_ETCO₂可减轻神经系统损伤,维持呼吸参数平稳,降低POCD发生率。更多还原

【Abstract】 Objective To observe the effect of end-tidal CO₂ partial pressure(P_ETCO₂) on postoperative cognitive function in elderly patients undergoing laparoscopic radical rectectomy（LRR）. Methods Eighty-four elderly patients withLRR were randomized to A group(P_ETCO₂=40-45 mm Hg) and B(P_ETCO₂=35-39 mm Hg) groups. Serum S100β protein level,tidal volume（V_T）, peak airway pressure（Ppeak）, arterial partial pressure of CO₂（PaCO₂）, arteriovenous oxygen content difference, and cerebral oxygen extraction rate were detected, and postoperative cognitive dysfunction（POCD） was evaluated by mini-mental state examination（MMSE）. Results The incidence of POCD, and serum level of S100β protein 6 h and 24 h postoperation were lower in A group than B group（P<0.01）. At 30 min and 60 min after pneumoperitoneum, V_T, Ppeak,arteriovenous oxygen content difference and cerebral oxygen extraction rate were decreased but PaCO₂ increased in A group compared with B group（P<0.05）. Conclusion P_ETCO₂ of 40-45 mm Hg can alleviate nervous system injury, maintain respiratory parameters, and reduce POCD incidence.更多还原