Clinical Research Of Low Pressure CO₂ Pneumoperitoneum On Early Cognitive Function In Patients Undergoing Laparoscopic Surgery

Objective Lately the ASA puts forward the goal of anesthesia: avoid intraoperative awareness,maintain the ideal hemodynamic changes steady,the best anesthesia recovery quality,avoid the postoperative cognitive dysfunction and avoid the perioperative death.Among these,the POCD is a kind of memory decline after anesthesia and surgery and attention can’t focus on the cognitive function such as a change,even the person that weigh loss of personality and social behavior will occur,the clinical manifestation of cognitive impairment anxiety impaired memory language understanding ability and the ability of social integration.This study means to discuss the application value of low pressure CO2 pneumoperitoneum on early postoperative cognitive function in patients undergoinggynecological laparoscopic surgery.Methods A total of ninety female patients,aged 40-60 years,scheduled for elective gynecological laparoscopic surgery were randomly into three groups(n=30).The pressure of CO2 pneumoperitoneum were set at 12-14,9-11 and 6-8 mm Hg in group H,group M and group L respectively.All of the patient were tested by the mini-mental state examination(MMSE)、verbal memory test 、copy graphics test、numbers of attachment test(A)、numbers of attachment test(B)、numbers repeat test、delay verbal memory test and graphics memory test 24 hours before operation、24 hours after operation and 72 hours after operation.The venous blood samples 10 minutes before anesthesia(T1)、at the end of surgery(T2)、6 hours after surgery(T3)、24 hours after surgery(T4)and 72 hours after surgery(T5)were collected for NSE and S100β protein.p H、Pa CO2、Pao2、PPlat and PPeakwere recorded before anesthesia(Ta)、before pneumoperitoneum(Tb)、 1 hour after pneumoperitoneum(Tc)、 2 hours after pneumoperitoneum(Td)and 1 hour(Te)after stopping pneumoperitoneum.The quantity of patients with shoulder pain was written 1 day after operation.Then,calculate the incidence rates of shoulder pain in the three groups.Results Compared with group H,the concentration of NSE at T2~ T3 was significantly lower in group L and group M(P<0.05).Compared with group H,the concentration of S100βprotein at T2 was significantly lower in group L and group M(P<0.05).Pa O2 in three groups was not different at Ta~Te.Compared with group L,p H at Tc~ Td was significantly decreased in group M and group H(P <0.05).Compared with group L,Pa CO2 was significantly increased at Tc~Te in group M and group H(P<0.05).Scores of these tests in three groups were not different and there was no POCD patients after surgery.The cases of shoulder pain in the group H were higher than group L 1 day after operation.Conclusion The low CO2 pneumoperitoneum pressure can reduce the release of NSE and S100β protein but has no obvious effect on early cognitive function in female patients undergoing gynecological laparoscopic surgery.