2026 年第 1 期 第 21 卷

允许性高碳酸血症对行腹腔镜手术的老年患者术中脑氧合及术后早期认知功能的影响

Effect of permissive hypercapnia on intraoperative cerebral oxygenation and early postoperative cognitive function in elderly patients undergoing laparoscopic surgery

作者：袁莉1张晓敏1刘娜1施俊琦1孙晓洁2李国利1滕金亮1

英文作者：Yuan Li1 Zhang Xiaomin1 Liu Na1 Shi Junqi1 Sun Xiaojie2 Li Guoli1 Teng Jinliang1

单位：1河北北方学院附属第一医院麻醉科，张家口075000；2河北北方学院附属第一医院重症监护室，张家口075000

英文单位：1Department of Anesthesiology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 2Intensive Care Unit the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：允许性高碳酸血症；目标导向液体治疗；腹腔镜手术；局部脑氧饱和度；术后认知功能障碍

英文关键词：Permissivehypercapnia;Goal-directedfluidtherapy;Laparoscopicsurgery;Regionalcerebraloxygensaturation;Postoperativecognitivedysfunction

• 摘要：

• 目的 探讨在目标液体治疗的基础上对行腹腔镜结直肠癌根治的老年患者给予高碳酸血症通气模式，观察患者术中局部脑氧饱和度的变化以及术后认知功能的情况。方法 选取2023年7月至2024年6月在河北北方学院附属第一医院择期行腹腔镜结直肠癌手术患者60例。采用随机数字表法分为对照组和观察组，每组30例。2组患者均在目标导向液体治疗的指导下进行补液。通过调节呼吸参数使对照组术中动脉血二氧化碳分压（PaCO2）35～45 mmHg(1 mmHg=0.133 kPa)，pH 7.35～7.45；观察组PaCO2 46～55 mmHg，pH 7.25～7.35。比较2组患者一般资料、不同时点［术前(T0)、气腹前5 min(T1)、气腹后20 min(T2)、气腹后1 h(T3)、气腹后2 h(T4)、气腹结束后20 min(T5)］PaCO2、术中脑氧饱和度（rSO2）及动脉血气分析结果、脑氧代谢指标、血清中认知功能指标、术后早期认知功能指标。结果 2组患者一般资料比较差异均无统计学意义（均P＞0.05）。与T0时比较，观察组患者T2～T5时PaCO2升高，pH值降低，rSO2升高（均P＜0.05）；观察组患者T2～T4时PaCO2和rSO2均高于对照组，T2～T5时pH值均低于对照组（均P＜0.05）。气腹后1 h，观察组患者颈内静脉血氧饱和度高于对照组，动脉-颈内静脉血氧含量差和脑氧摄取率均低于对照组（均P＜0.05）。术后1 d，观察组患者脑源性神经营养因子高于对照组，神经元特异性烯醇化酶和同型半胱氨酸均低于对照组（均P＜0.05）。与术前1 d比较，2组患者术后1 d简易精神状态检查量表（MMSE）评分降低；观察组手术后1 d MMSE评分高于对照组（均P＜0.05）。观察组术后认知功能障碍发生率低于对照组［10.0%(3/30)比36.7%（11/30）］（P＜0.05）。结论 在目标液体治疗基础上，对行腹腔镜结直肠癌根治的老年患者进行允许性高碳酸血症通气模式，可增加脑血流量，升高rSO2，降低脑氧代谢水平，减少认知功能损伤，有助于术后的快速康复。

• Objective To investigate the effect of hypercapnia ventilation mode on elderly patients undergoing laparoscopic radical resection of colorectal cancer on the basis of goal-directed fluid therapy, and to observe the changes of intraoperative regional cerebral oxygen saturation and postoperative cognitive function. Methods A total of 60 elderly patients scheduled for elective laparoscopic radical resection of colorectal cancer in the First Affiliated Hospital of Hebei North University from July 2023 to June 2024 were selected. They were divided into a control group and an observation group by random number table method, with 30 cases in each group. Both groups received fluid replacement under the guidance of goal-directed fluid therapy. Respiratory parameters were adjusted to maintain intraoperative arterial partial pressure of carbon dioxide (PaCO2) at 35-45 mmHg and pH 7.35-7.45 in the control group, while in the observation group, PaCO2 was maintained at 46-55 mmHg and pH 7.25-7.35. The general data, PaCO2 at different time points ［preoperatively (T0), 5 min before pneumoperitoneum (T1), 20 min after pneumoperitoneum (T2), 1 h after pneumoperitoneum (T3), 2 h after pneumoperitoneum (T4), and 20 min after the end of pneumoperitoneum (T5)］, intraoperative regional cerebral oxygen saturation (rSO2), results of arterial blood gas analysis, cerebral oxygen metabolism indicators, serum cognitive function indicators, and early postoperative cognitive function indicators were compared between the two groups. Results There were no statistically significant differences in general data between the two groups (all P＞0.05). Compared with T0, PaCO2 and rSO2 in the observation group increased, while pH decreased at T2-T5 (all P＜0.05). PaCO2 and rSO2 at T2-T4 in the observation group were higher than those in the control group; pH at T2-T5 in the observation group were lower than those in the control group (all P＜0.05). At 1 h after pneumoperitoneum, the internal jugular venous oxygen saturation in the observation group was higher than that in the control group, while the arterial-internal jugular venous oxygen content difference and cerebral oxygen extraction rate were lower than those in the control group (all P＜0.05). The level of brain-derived neurotrophic factor on the first day after surgery in the observation group was higher than that in the control group, and the levels of neuron-specific enolase and homocysteine were lower than those in the control group (all P＜0.05). Compared with the day before surgery, the Mini-Mental State Examination (MMSE) scores of both groups decreased on the first day after surgery; the MMSE score of the observation group on the first day after surgery was higher than that of the control group (all P＜0.05). The incidence of postoperative cognitive dysfunction in the observation group was lower than that in the control group ［10.0%(3/30) vs 36.7%(11/30)］(P＜0.05). Conclusion  On the basis of goal-directed fluid therapy, the application of permissive hypercapnia ventilation mode in elderly patients undergoing laparoscopic radical resection of colorectal cancer can increase cerebral blood flow, elevate rSO2, reduce cerebral oxygen metabolism level, mitigate cognitive function impairment, and contribute to the rapid postoperative recovery of patients.