Effect of permissive hypercapnia on carotid artery blood flow and early cognitive function in elderly patients under-going laparoscopic cholecystectomy
Objective To observe the effect of permissive hypercapnia(PHC)ventilation strategy after pneumoperitoneum established by laparoscopic cholecystectomy(LC)on internal carotid artery(ICA)flow and early cognitive function in elderly patients.Methods A total of 90 elderly patients performed LC under general anesthesia were enrolled,which included 45 males and 45 females,aged 65-80 years old with mean age of 71.00 years old(standard deviation 6.71 years old);height was 150-185 cm with mean height of 163.77 cm(standard deviation 9.35 cm);body mass was 46-90 kg with mean body mass of 66.98 kg(standard deviation 9.60 kg).According to American Society of Anesthesiologists(ASA)classification,there were 73 cases of grade Ⅱ and 17 of grade Ⅲ.According to New York Heart Association(NYHA)classification,there were 79 cases of grade Ⅱ and 11 of grade Ⅲ.There were 20 cases of primary school education,60 of middle school education and 10 of university education.All of them were randomly divided into PHC group(group H,n=45)and conventional ventilation group(group C,n=45).All patients were treated with conventional ventilation mode before operation,after establishment of pneumoperitoneum,the arterial partial pressure of carbon dioxide(PaCO2)in group C was adjusted to 35-45 mmHg and PaCO2 in group H was adjusted to 46-55 mmHg.The regional cerebral oxygen saturation(rSO2),peak systolic velocity-right ICA(PSV-RICA),end diastolic ve-locity-right ICA(EDV-RICA),velocity mean-right ICA(VM-RICA),quantity-right ICA(Q-RICA),quantity-left ICA(Q-LICA),peak systolic velocity-right common carotid artery(PSV-RCC A),heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),nasopharyngeal temperature,arterial blood gas,PaCO2,partial pressure of arterial oxygen(PaO2),lactic acid(Lac),blood glu-cose(Glu),hemoglobin(Hb)were recorded before anesthesia induction(T0),after anesthesia induction(T1),after pneumoperitoneum stabilization target value 15 minutes(T2),after pneumoperitoneum stabilization target value 30 minutes(T3),suturing skin comple-tion(T4).The mini-mental state examination(MMSE)score and cognitive abilities screening instrument(CASI)score were performed 1-day before operation,12-hour after operation,1-day after operation and before discharge.Results ①The postoperative hos-pitalization time in group H was shorter than that in group C[(4.60±0.65)days vs(5.17±0.84)days](t=2.915,P＜0.05);CO at T1,T2,T3 and T4 in group H were higher than those in group C(P＜0.05).PSV-RICA,PSV-RCCA and bilateral qual-right ICA(Q-ICA)at T2,T3 and T4 in group H were higher than those in group C(P＜0.05).The value of cerebral systemic vascular resis-tance(C-SVR)at T2 and T3 in group H were lower than those in group C(P＜0.05).②At T2,T3 and T4,rSO2,PaCO2 and Lac in group H were significantly higher than those in group C(P＜0.05).③The MMSE score at 12-hour after operation and before discharge in group H were higher than those in group C(P＜0.05).The CASI score at 12-hour,1-day after operation and before discharge in group H were higher than those in group C(P＜0.05).The MMSE score and CASI score at 12-hour and 1-day after operation in group C and group H were lower than those before operation(P＜0.05),and MMSE and CASI score before discharge were lower than those before operation in group C(P＜0.05).④For PHC,PSV-RICA was positively correlated with rSO2 at T1(P＜0.05),and the correlation was 0.261.PSV-RICA,PSV-RCCA and Q-RICA were correlated with rSO2 at T2,and correlation was 0.303,0.578 and 0.350,respectively.PSV-RICA,PSV-RCCA and Q-RICA were correlated with rSO2 at T3,and correlation was 0.259,0809 and 0.419,respectively.PSV-RICA,PSV-RCCA and Q-RICA were correlated with rSO2 at T4,and correlation was 0.387,0.785 and 0.263,respectively.For PHC,PSV-RICA was positively correlated with CO at T1,T2 and T4(R=0.265,0.422,0.405).PSV-RICA and Q-RICA were positively correlated with rSO2.Q-RICA was positively correlated with CO at T3(R=0.301).Conclusion It is demonstrated that PHC could increase ICA flow and peak flow rate in elderly patients performed LC,which improving cerebral perfusion and maintaining cerebral oxygen balance and demand in patients,and also be conducive to improve the recovery of early cognitive function after operation.
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