| Objective:To explore the effects of different intraoperative PETCO2 levels on cerebral oxygen metabolism and cognitive function of patients undergoing Da Vinci surgery under Trendelenburg position,so as to provide more options and clinical basis for perioperative brain function protection.Methods:A total of 60 elderly patients who were scheduled to receive Da Vinci robot-assisted laparoscopic prostatectomy and radical rectotomy in Affiliated Hospital of Qingdao University from June 2020 to June 2021 were selected as subjects.Age 55-80years old,ASAⅠ～Ⅲgrade,all patients were randomly divided into three groups by random number（n=21）:They were low level PETCO2group（group L,n=21）,whose PETCO2level was controlled in the range of 25～30mm Hg,medium level PETCO2group（group M,n=21）,whose PETCO2level was controlled in the range of 30～45mm Hg,and high level PETCO2group（group H,n=20）,whose PETCO2level was controlled in the range of 45～50mm Hg.Blood gas analysis was performed on the radial artery and jugular bulbous blood samples of patients before entering the operating room for anesthesia（T0）,starting pneumoperitoneum（T1）,30min after starting pneumoperitoneum（T2）,90min after starting pneumoperitoneum（T3）,and after ending the pneumoperitoneum position for recovery（T4）.Heart rate（HR）,mean arterial pressure（MAP）,central Venous Pressure（CVP）,End-tidal carbon dioxide partial pressure(PETCO2),potential of hydrogen（p H）,temperature（T）,oxygen pressure（PO2）,Bispectral index（BIS）,jugular bulb venous oxygen saturation（Sjv O2）and optic nerve sheath diameter（ONSD）were recorded at each time point.And 1 day before surgery,postoperative 1 day,3 days,7 days for patients with mini–mental state examination（MMSE）score were recorded.postoperative cognitive dysfunction（POCD）events in patients were recorded within 7 days after surgery.Results:A total of 60 patients were included in this study,and there were 18 males and 3females in group L,aged 55-80 years,with an average age of（67.90±7.63）years.BMI19.68～31.41,average（25.23±2.74）.There were 19 males and 2 females in group M,aged 57-77 years,with an average age of（68.29±5.54）years.Bmi20.93-30.15,mean（25.94±2.42）H group,19 males and 2 females,age 55-78 years old,mean（67.57±6.21）;BMI21.60～30.46,average（25.80±3.02）.There was no significant difference in general data among the three groups（P>0.05）.（Operation type and operation duration were different between the two groups.）There were no significant differences in HR,CVP and MAP among the three groups at each time point（P>0.05）.At the time points of T2,T3and T4,there were significant differences among the hemoglobin groups in groups L,M and H（T2:F=5.010,P=0.010;T3:F=5.810,P=0.005;T4:F=4.639,P=0.014）.There were no significant differences in BIS among the three groups at each time point（P>0.05）.Sjv O2was significantly different at T1,T2and T3（T1:F=3.764,P=0.029;T2:F=11.312,P<0.001;T3:F=17.264,P<0.001）,group H>group M>group L at the three time points,there was no significant difference between groups at T0and T4（T0:F=0.045,P=0.956;T4:F=0.999,P=0.375）;The diameter of ONSD was significantly different at T1,T2and T3（P<0.05）,and was in group H>group M>group L at each time point（T1:F=9.083,P<0.001;T2:F=6.869,P=0.002;T3:F=7.247,P=0.002）;MMSE scores of all groups were significantly decreased 1 day after surgery compared with MMSE scores of 1 day before surgery（P<0.05）,and there was no significant difference in MMSE scores among all groups（P>0.05）.There was no significant difference in MMSE scores between groups 3 days after surgery and 7 days after surgery,and no significant difference compared with surgery（P>0.05）.Conclusions:The change of PETCO2 level can affect the cerebral oxygen metabolism and postoperative cognitive dysfunction of patients.Maintaining a high level of PETCO2during the operation is conducive to maintaining the balance of cerebral oxygen supply and demand and metabolic stability of patients,and can reduce the risk of postoperative cognitive dysfunction. |
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