目的 探讨不同PEEP水平联合PCV-VG通气模式对腹腔镜大肠癌根治术老年患者脑氧饱和度和血清神经胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)的影响。方法 选择择期行腹腔镜大肠癌根治术的老年患者90例，随机分为3组：PEEP=0cmH2O（A组），PEEP=5cmH2O（B组），PEEP值为肺动态顺应性滴定法下最适PEEP（C组），每组30例，三组患者均采用压力控制容量保证通气模式（PCV-VG）。记录麻醉诱导前（T0）、插管即刻（T1）、Trendelenburg体位后30min（T2）、Trendelenburg体位后60min（T3）、手术结束时（T4）及拔管后10min（T5)的rSO2；于T0、T5采集静脉血标本，检测血清GFAP、NSE的浓度。结果T2、T3、T4时，与T0相比，三组患者rSO2在均升高（P<0.05），与A组相比，B组、C组rSO2明显增加（P<0.05）。与T0相比，三组患者在T5时血清NSE、GFAP值均升高（P<0.05）。结论 个体化滴定的PEEP联合PCV-VG通气模式可改善腹腔镜大肠癌根治术老年患者术中rSO2。

Abstract: Objective: To investigate the effects of different PEEP levels combined with PCV-VG ventilation mode on cerebral oxygen saturation and serum glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) in elderly patients undergoing laparoscopic radical colorectal cancer surgery. Methods: Ninety elderly patients undergoing elective laparoscopic radical colorectal cancer surgery were selected and randomly divided into three groups: PEEP=0cmH2O (group A), PEEP=5cmH2O (group B), and when the lung dynamic compliance reached the maximum, PEEP value was determined the optimal PEEP (group C), 30 patients in each group, and pressure-controlled volume-guaranteed ventilation mode (PCV-VG) was used in all three groups. The rSO2 was recorded before induction of anesthesia (T0), immediately after intubation (T1), 30 min after Trendelenburg position (T2), 60 min after Trendelenburg position (T3), at the end of surgery (T4) and 10 min after extubation (T5); venous blood specimens were collected at T0 and T5, and the concentrations of serum GFAP and NSE were measured. Results: Compared to T0, at T2, T3 and T4, rSO2 was elevated in all three groups (P<0.05) and was significantly higher in group B and C compared to groups A at T2, T3 and T4 (P<0.05). Serum NSE and GFAP values were increased in all three groups at T5 compared with T0 (P<0.05). Conclusion Individualized titration of PEEP combined with PCV-VG ventilation mode can improve intraoperative rSO2.