2026 年第 9 期 第 21 卷

允许性高碳酸血症对老年腹腔镜结直肠癌手术患者肺功能及术后认知功能的影响

Effects of permissive hypercapnia on pulmonary function and postoperative cognitive function in elderly patients undergoing laparoscopic colorectal cancer surgery

作者：李向博滕金亮袁莉

英文作者：Li Xiangbo Teng Jinliang Yuan Li

单位：河北北方学院附属第一医院麻醉科，张家口075000

英文单位：Department of Anesthesiology The First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：允许性高碳酸血症；腹腔镜手术；肺功能；术后认知功能障碍

英文关键词：Permissivehypercapnia；Laparoscopicsurgery；Pulmonaryfunction；Postoperativecognitivedysfunction

• 摘要：

• 目的 探究允许性高碳酸血症（PHC）对老年腹腔镜结直肠癌手术患者肺功能及术后认知功能的影响。方法 选取2023年12月至2024年12月于河北北方学院附属第一医院择期行腹腔镜结直肠癌手术的120例老年患者，采用随机数字表法分为PHC组（P组）和常规通气组（C组），每组60例。P组患者术中动脉血二氧化碳分压（PaCO2）维持在46～55 mmHg（1 mmHg=0.133 kPa），C组患者PaCO2控制在35～45 mmHg。记录患者一般临床指标及手术信息；分别于气腹前5 min及气腹后5、15、30 min记录呼气末二氧化碳分压（PETCO2），采集桡动脉和颈内静脉球部静脉血进行血气分析，记录相应时点pH值、PaCO2，计算动脉-颈内静脉血氧含量差（Da-jvO2）和脑氧摄取率（CERO2）。于气腹前、气腹后10 min及放气后10 min检测2组肺功能参数，包括气道峰压（Ppeak）、静态肺顺应性（Cst）和动态肺顺应性（Cdyn）。术前、术后24 h及术后48 h检测患者血清中神经元特异性烯醇化酶（NSE）、β淀粉样蛋白（Aβ）和S100β蛋白含量。记录术前1 d及术后1、3、7 d蒙特利尔认知评估量表（MoCA）评分，统计术后认知功能障碍（POCD）发生情况。结果 与气腹前5 min相比，2组气腹后5、15、30 min的PETCO2和PaCO2均显著升高，pH值、Da-jvO2和CERO2均明显降低（均P＜0.05）。与C组相比，P组气腹前5 min及气腹后5、15、30 min 的PETCO2和PaCO2升高更显著，pH值、Da-jvO2和CERO2降低更明显（均P＜0.05）。肺功能方面，气腹后10 min和放气后10 min，P组Ppeak显著低于C组，Cst和Cdyn显著高于C组（均P＜0.05）。术后认知功能指标方面，P组术后24 h及48 h血清NSE、Aβ和S100β水平显著低于C组，术后1 d和3 d MoCA评分显著高于C组，POCD发生率显著低于C组（均P＜0.05）。结论 允许性高碳酸血症应用于老年腹腔镜结直肠癌手术患者，可改善术中脑氧代谢，降低术后血清NSE、Aβ和S100β蛋白浓度，降低POCD发生率，减轻术中肺功能损伤，促进术后快速康复，具有较高临床应用价值。

• Objective To explore the effects of permissive hypercapnia (PHC) on pulmonary function and postoperative cognitive function in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods A total of 120 elderly patients undergoing elective laparoscopic colorectal cancer surgery in The First Affiliated Hospital of Hebei North University from December 2023 to December 2024 were enrolled and divided into the PHC group (Group P) and conventional ventilation group (Group C) by the random number table method, with 60 patients in each group. In Group P, intraoperative arterial partial pressure of carbon dioxide (PaCO2) was maintained at 46-55 mmHg, while PaCO2 in Group C was controlled at 35-45 mmHg. General clinical indicators and surgical data were recorded. End-tidal partial pressure of carbon dioxide (PETCO2) was recorded at 5 min before pneumoperitoneum and 5, 15, 30 min after pneumoperitoneum. Blood gas analysis was performed on radial artery and jugular bulb venous blood, pH value and PaCO2 at corresponding time points were recorded, and arterial-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction rate (CERO2) were calculated. Pulmonary function parameters including peak airway pressure (Ppeak), static lung compliance (Cst) and dynamic lung compliance (Cdyn) were detected in both groups before pneumoperitoneum, 10 min after pneumoperitoneum and 10 min after desufflation. Serum levels of neuron-specific enolase (NSE), β-amyloid protein (Aβ) and S100β protein were detected before operation, at 24 h and 48 h after operation. Montreal cognitive assessment (MoCA) scores were recorded at 1 d before operation and 1, 3, 7 d after operation, and the incidence of postoperative cognitive dysfunction (POCD) was statistically analyzed. Results Compared with 5 min before pneumoperitoneum, PETCO2 and PaCO2 were significantly increased, while pH value, Da-jvO2 and CERO2 were markedly decreased at 5, 15, 30 min after pneumoperitoneum in both groups (all P＜0.05). Compared with Group C, the increases in PETCO2 and PaCO2 and the decreases in pH value, Da-jvO2 and CERO2 were more significant at 5 min before pneumoperitoneum and 5, 15, 30 min after pneumoperitoneum in Group P (all P＜0.05). In terms of pulmonary function, at 10 min after pneumoperitoneum and 10 min after desufflation, Ppeak in Group P was significantly lower, while Cst and Cdyn were significantly higher than those in Group C (all P＜0.05). For postoperative cognitive function indicators, serum NSE, Aβ and S100β levels at 24 h and 48 h after operation in Group P were significantly lower, MoCA scores at 1 d and 3 d after operation were significantly higher, and the incidence of POCD was significantly lower than those in Group C (all P＜0.05). Conclusion The application of permissive hypercapnia in elderly patients undergoing laparoscopic colorectal cancer surgery can improve intraoperative cerebral oxygen metabolism, reduce postoperative serum concentrations of NSE, Aβ and S100β protein, lower the incidence of POCD, alleviate intraoperative pulmonary function injury, and promote enhanced postoperative recovery, which possesses high clinical application value.