CAJ | 학술논문

目的：评价不同呼吸参数对妇科腹腔镜手术患者术后早期认知功能的影响。方法择期行腹腔镜下卵巢癌或宫颈癌根治术患者80例,年龄30~60岁,均采用丙泊酚复合瑞芬太尼静脉全身麻醉,按照随机数字表法分为四组：A 组,VT 8 ml/kg,RR 12次/分；B、C、D 组分钟通气量(MV)均为105 ml/kg,RR 分别为12、15、18次/分。分别于术前(T0)、术后1 h(T1)、6 h(T2)、24 h (T3)、48 h(T4)、72 h(T5)进行简易精神状态量表(MMSE)评分。分别于麻醉后气腹前(Ta)、放气腹即刻(Tb)测定患者 PaCO2。结果与 Ta 时比较,Tb 时四组患者 PaCO2明显升高(P <0.05)。Tb时,A 组 PaCO2明显高于其余三组(P <0.05),C 组明显低于其余三组(P <0.05)。T1~T3时 C 组MMSE 评分明显高于其余三组(P <0.05),T4时 A 组明显低于其余三组(P <0.05)。T1~T4时 A组,T1~T3时 B、D 组,T1、T2时 C 组 MMSE 评分明显低于 T0时(P <0.05)。结论妇科腹腔镜手术对患者术后早期认知功能有影响,通过合理调节呼吸参数、适当增加 MV 可以降低妇科腹腔镜术后早期认知功能障碍。
목적：평개불동호흡삼수대부과복강경수술환자술후조기인지공능적영향。방법택기행복강경하란소암혹궁경암근치술환자80례,년령30~60세,균채용병박분복합서분태니정맥전신마취,안조수궤수자표법분위사조：A 조,VT 8 ml/kg,RR 12차/분；B、C、D 조분종통기량(MV)균위105 ml/kg,RR 분별위12、15、18차/분。분별우술전(T0)、술후1 h(T1)、6 h(T2)、24 h (T3)、48 h(T4)、72 h(T5)진행간역정신상태량표(MMSE)평분。분별우마취후기복전(Ta)、방기복즉각(Tb)측정환자 PaCO2。결과여 Ta 시비교,Tb 시사조환자 PaCO2명현승고(P <0.05)。Tb시,A 조 PaCO2명현고우기여삼조(P <0.05),C 조명현저우기여삼조(P <0.05)。T1~T3시 C 조MMSE 평분명현고우기여삼조(P <0.05),T4시 A 조명현저우기여삼조(P <0.05)。T1~T4시 A조,T1~T3시 B、D 조,T1、T2시 C 조 MMSE 평분명현저우 T0시(P <0.05)。결론부과복강경수술대환자술후조기인지공능유영향,통과합리조절호흡삼수、괄당증가 MV 가이강저부과복강경술후조기인지공능장애。
Objective To investigate the influence of different respiratory parameter setting during gynecological laparoscopic surgery on early postoperative cognitive function.Methods Eighty patients undergoing elective ovarian cancer or cervical cancer were grouped randomly into groups A, B,C and D.In group A patients were ventilated with respiratory parameters of VT 8 ml/kg,RR 12 times/min.While patients in groups B,C and D with identical minute volume 105 ml/kg though with respective RR of 12,1 5 and 18 times/min respectively.Patients in four groups were all graded by the MMSE at time points of preoperation(T0 ),postoperative 1 h(T1 ),6 h(T2 ),24 h(T3 ),48 h(T4 ), 72 h(T5 ).PaCO2 of arterial blood gas were tested before pneumoperitoneum(Ta)and immediately af-ter pneumoperitoneum(Tb).Results PaCO2 at Tb was higher in each group than that at Ta(P <0.05).Patients in group A showed the highest PaCO2 at Tb while PaCO2 in group C were lowest. The MMSE scores in group C were significantly higher than those in other groups at T1-T3 (P <0.05).The values at T4 in group A were lower (P <0.05)than those in other groups.Values at T1-T4 in group A were lower than that at T0 (P <0.05).In groups B and D at T1-T3 MMSE scores were lower than those at T0 and patients in group C showed lower MMSE scores at T1 and T2 (P <0.05).Conclusion Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly and increasing minute volume adequately in gynecological laparoscopic surgery.