【摘要】 目的:观察不同CO₂气腹压力对老年患者腹腔镜直肠癌术后认知功能、脑应激因子及脑供氧水平的影响。方法:为80例年龄≥60岁的中低位直肠癌患者行腹腔镜直肠癌前切除术,将患者随机分为CO₂气腹低压力组（10 mmHg,低压组）与高压力组（15 mmHg,高压组）,每组40例。分别于术前1 d及术后第1天、第3天、第7天采用简易智能精神状态检查量表判断术后认知功能障碍程度;术前1 d、术后第3天采用酶联免疫吸附法测定血清中枢神经特异性蛋白（S100β）、脑源性神经营养因子（BDNF）、β-淀粉样蛋白与微管相关蛋白比值（Aβ-42/tau）水平;于气腹前即刻（T₀）、气腹后30 min（T₁）、60 min（T₂）、90 min（T₃）进行血气分析。结果:术前1 d,两组智能精神状态评分差异无统计学意义（P>0.05）,术后第1天、第3天、第7天,两组均较术前1 d出现不同程度降低（P<0.05）,高压组降低更明显（P<0.05）。术前1 d,两组血清S100β、BDNF、Aβ-42/tau水平差异无统计学意义（P>0.05）;术后第3天,两组血清S100β水平升高（P<0.05）,BDNF及Aβ-42/tau水平下降（P<0.05）;低压组S100β水平低于高压组,BDNF、Aβ-42/tau水平高于高压组,差异有统计学意义（P<0.05）。与T₀相比,T₁、T₂、T₃时,两组颈静脉球血氧饱和度、动脉血二氧化碳分压均增加（P<0.05）,脑动脉-颈内静脉血氧含量差减少（P<0.05）。结论:腹腔镜手术中采用较低的CO₂气腹压力可减少老年患者术后认知功能障碍发生风险,改善脑应激因子水平、大脑氧代谢。更多还原

【Abstract】 Objective:To observe the effects of different CO₂ pneumoperitoneum pressure on cognitive function,brain stress factors and brain oxygen supply level after laparoscopic surgery for elderly rectal cancer.Methods:Eighty patients of middle and low rectal cancer underwent laparoscopic anterior resection of rectal cancer with age ≥60 years,and they were randomly divided into the CO₂ pneumoperitoneum low-pressure group（10 mmHg） and the high-pressure group（15 mmHg）,with 40 cases in each group.The mini-mental state examination（MMSE） was used to judge the degree of postoperative cognitive dysfunction one day before surgery and one day,three days and seven days after surgery.Serum levels of S100β,brain-derived neurotrophic factor（BDNF） and Aβ-42/tau were measured by enzyme linked immunosorbent assay one day before and three days after surgery.Blood gas analysis was performed immediately before the pneumoperitoneum（T₀）,30 min（T₁）, 60 min（T₂）,and 90 min（T₃） after the pneumoperitoneum.Results:There was no significant difference in MMSE score between the two groups before anesthesia（P>0.05）,and the two groups showed different degrees of decrease on day 1,day 3,and day 7 after surgery compared with those before anesthesia（P<0.05）,and the decrease was more significant in the high-pressure group（P<0.05）.Before anesthesia,there was no significant difference in serum S100β,BDNF and Aβ-42/tau levels between the two groups（P>0.05）.On postoperative day 3,serum S100β levels of the two groups were significantly increased（P<0.05）,while levels of BDNF and Aβ-42/tau levels were significantly decreased（P<0.05）.After surgery,the level of S100β in the low-pressure group was significantly lower than that in the high-pressure group on day 3,and the level of BDNF and Aβ-42/tau was significantly higher than that in the high-pressure group（P<0.05）.Compared with T₀,jugular bulb venous oxygen saturation and PaCO₂ increased significantly at T₁, T₂ and T₃（P<0.05）,and cerebral arterial-jugular venous oxygen difference decreased significantly（P<0.05）.Conclusions:Low CO₂ pneumoperitoneum pressure during laparoscopic surgery can reduce the risk of postoperative cognitive dysfunction in elderly patients,and improve the level of brain stress factors and brain oxygen metabolism.更多还原