CAJ | 학술논문

目的：观察机器人辅助腹腔镜前列腺癌根治术中二氧化碳气腹及Trendelenburg体位对老年患者脑氧饱和度及脑血液回流的影响。方法择期行机器人腹腔镜下前列腺癌根治术的患者100例，以年龄分组，老年组：65~80岁；中年组：45~64岁，每组50例。全麻插管后，分别于气腹前（T0）、气腹后10 min（T1）、Trendelenberg体位后10 min（T2）、Trendelenberg体位后60 min（T3）、停气腹平卧后10 min（T4）抽取颈静脉球和桡动脉血进行血气分析。观察记录指标：（1）脑氧饱和度；（2）颈静脉球氧饱和度；（3）颈静脉球压力；（4）脑动静脉氧含量差；（5）颈内静脉血糖和乳酸的变化。结果与气腹前（T0）比较，两组患者在T1~T4各时刻脑氧饱和度、颈静脉球氧饱和度、颈静脉球压力升高，差异有统计学意义（P<0.01）；脑动静脉氧含量差下降，差异有统计学意义（P<0.01）；与中年组组比较，老年组在T2、T3时刻脑氧饱和度、颈内静脉血氧饱和度、颈静脉球压力升高，差异有统计学意义（P<0.01），脑动静脉氧含量差降低，差异有统计学意义（P<0.01）；两组颈静脉血糖、乳酸含量差别无统计学意义（P>0.05）。结论二氧化碳气腹及Trendelenburg体位使老年患者脑血流增加更加明显，但并不引起脑氧代谢改变。
목적：관찰궤기인보조복강경전렬선암근치술중이양화탄기복급Trendelenburg체위대노년환자뇌양포화도급뇌혈액회류적영향。방법택기행궤기인복강경하전렬선암근치술적환자100례，이년령분조，노년조：65~80세；중년조：45~64세，매조50례。전마삽관후，분별우기복전（T0）、기복후10 min（T1）、Trendelenberg체위후10 min（T2）、Trendelenberg체위후60 min（T3）、정기복평와후10 min（T4）추취경정맥구화뇨동맥혈진행혈기분석。관찰기록지표：（1）뇌양포화도；（2）경정맥구양포화도；（3）경정맥구압력；（4）뇌동정맥양함량차；（5）경내정맥혈당화유산적변화。결과여기복전（T0）비교，량조환자재T1~T4각시각뇌양포화도、경정맥구양포화도、경정맥구압력승고，차이유통계학의의（P<0.01）；뇌동정맥양함량차하강，차이유통계학의의（P<0.01）；여중년조조비교，노년조재T2、T3시각뇌양포화도、경내정맥혈양포화도、경정맥구압력승고，차이유통계학의의（P<0.01），뇌동정맥양함량차강저，차이유통계학의의（P<0.01）；량조경정맥혈당、유산함량차별무통계학의의（P>0.05）。결론이양화탄기복급Trendelenburg체위사노년환자뇌혈류증가경가명현，단병불인기뇌양대사개변。
Objective To observe the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on cerebral blood backflow during robot-assisted radical prostatectomy in elderly patients. Methods Fifty elderly patients (65-80 years) and 50 middle-aged patients (45-64 years) undergoing elective robot-assisted prostatectomy were enrolled in this study. For all the patients, jugular bulb and arterial blood gas was monitored and recorded before pneumoperitoneum (T0), 10 min after pneumoperitoneum was achieved (T1), 10 min (T2) and 60 min (T3) after Trendelenberg position, and 10 min in supine position after termination of pneumoperitoneum (T4). Results Compared with those at T0, the mean arterial pressure, heart rate, and BIS value at T1, T2, T3 and T4 all showed no significant variations (P>0.05), but rSO2, SjvO2, and JBP increased significantly in both groups (P<0.01). Compared with those in the middle-aged group, rSO2, SjvO2, and JBP increased significantly and Da-jO2 decreased at T2, T3 in the elderly group (P<0.01), but jugular vein blood glucose or lactic acid content showed no significant difference between the two groups (P>0.05). Conclusion Pneumoperitoneum and Trendelenburg position cause more obvious cerebral blood backflow in elderly patients than in middle-aged patients but do not affect cerebral metabolism of oxygen.