Effect of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in elderly patients with chronic obstructive pulmonary disease by laparoscopic surgery
10.7619/jcmp.201809005
- VernacularTitle:允许性高碳酸血症机械通气对腹腔镜手术老年轻度慢阻肺患者脑组织氧合及术后认知功能的影响
- Author:
Ruilian WAN
1
;
Qing ZHANG
Author Information
1. 安徽医科大学附属合肥医院麻醉科
- Keywords:
hypercapia;
cerebral oxygen saturation;
cognitive function;
laparoscopic surgery
- From:
Journal of Clinical Medicine in Practice
2018;22(9):20-23
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate effects of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in laparoscopy in elderly patients with mild COPD.Methods Sixty elderly patients with mild obstructive pulmonary disease undergoing elective laparoscopy under general anesthesia were randomly divided into routine ventilation group (group N) and permissive hypercapnia ventilation group(group H).Blood samples were collected to implement blood gas analysis at 10 min(T0) after endotracheal intubation,50 min (T1) and 100 min (T2) after pneumoperitoneum,and 10 min after exhaust (T3).Blood oxygen content differences of arterial-internal jugular vein (Da-jv02) and cerebral oxygen extraction rate (CERO2) were calculated at the same time.Cerebral oxygen saturation (rSO2) was monitored all the time.Cognitive function was assessed by Montreal Cognitive Assessment Scale (MoCA) at 1 d before operation,and 1d and 3d after operation.Results Compared with group N,p(CO2) and rSO2were significantly increased,and pH value,Da-jvO2 and CERO2 were significantly decreased,MoCA score was significantly increased after operation,and the incidence of post-operative cognitive dysfunction was significantly decreased after operation (P ＜ 0.05).Compared with the baseline value at T0,Da-jvO2 and CERO2 were significantly decreased,rSO2 were significantly increased,and MoCA scores at 1 to 3 d were reduced in two groups.Compared with baseline at To,group H had increased p(CO2),rSO2,increased pH value,Da-jvO2 and CERO2,at T1 ～3 (P ＜ 0.05).Conclusion Permissive hypercapnia ventilation can improve the cerebral oxygen metabolism during laparoscopic surgery,and reduce post-operative cognitive dysfunction in the elderly patients with mild chronic obstructive pulmonary disease.
