Correlation between pneumoperitoneum pressure, level of blood uric acid and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy / 中国医师进修杂志

ABSTRACT

Objective:To study the correlation between pneumoperitoneum pressure, level of blood uric acid (UA) and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy (LC).Methods:One hundred and one patients from December 2018 to December 2019 in Wuhu First People′s Hospital of Anhui Province were selected. According to average value of intraoperative pneumoperitoneum pressure, the patients were divided into low pressure group (intraoperative pneumoperitoneum pressure<11.2 mmHg, 1 mmHg = 0.133 kPa; 50 cases) and standard pressure group (intraoperative pneumoperitoneum pressure ≥ 11.2 mmHg, 51 cases). According to preoperative average level of preoperative blood UA, the patients were divided into low-level UA group (UA<324.1 mmol/L, 50 cases) and high-level UA group (UA≥324.1 mmol/L, 51 cases). The cognitive function 24 h after surgery was assessed by mini-mental state examination (MMSE) scale and Loewenstein occupational therapy cognitive assessment (LOTCA) scale. The correlation between pneumoperitoneum pressure, level of blood UA and cognitive function was analyzed by Pearson correlation analysis.Results:There were no statistical differences in recovery time of spontaneous breathing, recovery time and extubation time between standard pressure group and low pressure group ( P>0.05); the recovery time of orientation in low pressure group was significantly shorter than that in standard pressure group (12.54 ± 2.41) min vs. (14.65 ± 2.88) min, the postoperative MMSE score and LOTCA score were significantly higher than those in standard pressure group (25.12 ± 2.03) scores vs. (20.84 ± 2.42) scores and (96.24 ± 6.54) scores vs. (85.15 ± 5.12) scores, and there were statistical differences ( P<0.01). The postoperative MMSE score and LOTCA score in high-level UA group were significantly higher than those in low-level UA group (24.76 ± 2.53) scores vs. (21.12 ± 2.06) scores and (94.86 ± 6.18) scores vs. (86.34 ± 5.27) scores, and there were statistical differences ( P<0.01). The Pearson correlation analysis result showed that pneumoperitoneum pressure was negative correlation with MMSE score and LOTCA score ( r = -0.544 and - 0.615, P<0.01); while UA level was positive correlation with MMSE score and LOTCA score ( r = 0.433 and 0.405, P<0.01). Conclusions:The carbon dioxide pneumoperitoneum pressure and UA level are related to postoperative cognitive function in elderly LC patients. The postoperative cognitive function is relatively better in patients with lower intraoperative pneumoperitoneum pressure and higher preoperative UA level.