尹增盛 李淑琴 崔辉

摘 要：目的 观察老年腹腔镜胆囊切除术患者术中不同压力二氧化碳气腹对其术后认知功能的影响。方法 选取2017年9月～2018年7月九江学院附属医院行腹腔镜胆囊切除术的老年患者80例，根据随机数字表法分为低压组与标准压组，各40例，观察患者术后认知功能及恢复情况。结果 低压组与标准压组术后恢复情况基本相同，差异无统计学意义（P>0.05）；两组麻醉诱导前、术后48 h、术后72 h MMSE评分比较，差异无统计学意义（P>0.05），术后6 h、术后24 h、术后48 h MMSE评分均低于麻醉诱导前（P<0.05），且标准压组术后6 h、术后24 h MMSE评分低于低压组（P<0.05）。结论 老年患者行腹腔镜胆囊切除术时，低二氧化碳气腹压力可能减轻对术后认知功能的影响。

关键词：腹腔镜胆囊切除术；二氧化碳气腹压力；老年患者；术后认知功能

中图分类号：R657.4；R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.024

文章编号：1006-1959（2018）20-0086-03

Abstract：Objective To observe the effect of different pressure carbon dioxide pneumoperitoneum on postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy.Methods 80 elderly patients undergoing laparoscopic cholecystectomy in Jiujiang University Affiliated Hospital from September 2017 to July 2018 were enrolled.According to the random number table method，they were divided into low pressure group and standard pressure group，40 cases each.Observe the postoperative cognitive function and recovery of the patient.Results The recovery of the low pressure group and the standard pressure group were basically the same，the difference was not statistically significant（P>0.05）.There was no significant difference in the MMSE scores between the two groups before and after anesthesia induction，48 h after surgery and 72 h after surgery（P>0.05），MMSE scores were lower than 6h after operation，24 h after operation and 48 h after operation（P<0.05），the MMSE scores of the standard compression group were lower than the low pressure group at 6 h and 24 h after operation（P<0.05）.Conclusion In elderly patients undergoing laparoscopic cholecystectomy，low carbon dioxide pneumoperitoneum may reduce the impact on postoperative cognitive function.

Key words：Laparoscopic cholecystectomy；Carbon dioxide pneumoperitoneum pressure；Elderly patients；Postoperative cognitive function

术后认知功能障碍（postoperation cognitive dysfunction，POCD）是指术前认知功能正常的患者，在麻醉手术后出现的一种急性中枢神经系统紊乱综合征。多数发病患者在麻醉后数天至数周出现焦虑、记忆受损、认知功能和理解力的下降以及社会融合能力减退[1-3]。腹腔镜胆囊切除术是一种微创手术，术中气腹和特殊体位对患者的生理干扰很大，相关研究证实，行腹腔镜手术的老年患者术后并发认知功能损害的风险更高[4，5]。本研究以九江学院附属医院行腹腔镜胆囊切除术治疗的老年患者为研究对象，在术中分别维持不同压力二氧化碳气腹，观察其术后认知功能情况，为临床应用提供参考。

1资料与方法

1.1一般资料 选择2017年9月～2018年7月在九江学院附属医院行腹腔镜胆囊切除术治疗的老年患者80例，本研究经医院医学伦理委员会批准。纳入……