| Objective: The paper aimed at exploring influences on early cognitive function of aged patients at early period after laparoscopic cholecystectomie imposed by different pneumoperitoneum pressures, and providing certain clinical basis for setting the reasonable pneumoperitoneum pressure before clinical operation, improving the safety at period perioperative, reducing the complication and improving the recovery rate.Method: Patients who received selective laparoscopic cholecystectomie at the department of hepatobiliary surgery of Chengdu Second People’s Hospital between December 2014 and February 2016 with their ages of 60~75 were divided into three groups by random number table. LP group(low pneumoperitoneum pressure group with the actual pneumoperitoneum pressure of 10 mm Hg); SP group(standard pneumoperitoneum pressure group with the actual pneumoperitoneum pressure of 12 mm Hg); HP group(high pneumoperitoneum pressure group with the actual pneumoperitoneum pressure of 14 mm Hg). 100 cases were selected randomly for three groups above respectively. The laparoscopic cholecystectomies were carried out under the combined anesthesia of vein. The blood gas analysis was carried out by getting radial artery blood of same side upper limb at the day before operation, 30 minutes after establishing stabile pneumoperitoneum during operation and 3 days after operation, record p H, Pa O2, Pa CO2. The anesthesia and operation condition were monitored during operation.Species and dosages of anesthesia induction, anesthesia maintenanceand relevant anesthetics were recorded. Record the VAS pain score at the day, 2 days and 3 days after operation. Record cognitive function MMSE score at the day before operation as well as the day, 2 days and 3 days after operation respectively. The occurrence rates of POCD were counted at the day, 2 days and 3 days after operation for three groups. The day after operation was the time point, the changes ofp H, Pa O2, Pa CO2 correlation analysis of correlation between the changes of p H, Pa O2, Pa CO2 and MMSE score decrease after operation. The above record data were statistically analyzed.Result: 1. There were no statistical differences in comparisons about general information, vital signs before operation, liquid intake and output volumes during operation, species and dosages of anesthetics, anesthesia depth, operation time, anesthesia time, sober time, postoperative VAS pain score among three groups(P>0.05). 2. There were no statistical differences comparisons among p H, Pa O2, Pa CO2 at the day before operation(P>0.05). The p H, Pa O2, Pa CO2 were significantly different at 30 minutes in operation and 3 days after operation(P<0.01), the HP group and the LP group were more obvious compared with each index. 3. There were no statistical differences in MMSE scores between the day before operation and 3 days after operation(P>0.05). However, the MMSE scores of the three groups were statistically significant at the day and 2 days after operation, the difference was significant at the day after operation, among them, the HP group compared with the LP group, the MMSE scores were significantly lower(P<0.01). In LP group,the MMSE scores were lower in the day after operation(P<0.05), and recovery to preoperative level 2 days after operation. Also in SP group, the MMSE scores were significantly lower in the day after operation(P<0.01), and recovery to preoperative level 2 days after operation. In HP group, the MMSE scores were significantly lower in the day and 2 days after operation(P<0.05), 3 days after operation, the MMSE scores were recovered but there was still lower compared with the day before operation(P<0.05). 4. On the basis of indexes levels before operation, the blood gas analysis in-dexes of three groups in the operation were analyzed, either the decreased p H, Pa O2 or increased Pa CO2 were positively related to decrease of MMSE rating after the operation, especially with HP group was more obvious. 5. There were some statistical differences in comparison of POCD occurrence rate among three groups at the day, 2 days and 3 days after operation(P<0.05). Wherein,the POCD incidence rate of HP group after the operation was obvioussly higher than that of LP group at the day and 2 days after operation(P<0.01).Conclusion: 1. The higher Pneumoperitoneum pressure more senile peritoneoscope gallbladder excision postoperative early cognitive function damage was more severe, longer duration, postoperative cognitive dysfunction in the early incidence higher. 2. The higher Pneumoperitoneum pressure caused by elderly laparoscopic gallbladder resection patients in blood p H, Pa O2 decreased and Pa CO2 increased more significantly, the changes and postoperative early changes in cognitive function of MMSE score into positive correlation. |
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