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目的：探究不同术式及术中维持不同动脉二氧化碳分压对老年人术后认知功能障碍（POCD）发生情况的影响。方法选取ASAⅠ～Ⅱ级择期全麻下行开腹及腹腔镜肾癌根治术的60～75岁病人67例，术中分别随机维持动脉二氧化碳分压于高（45～48 mmHg）、低（35～38 mmHg）两个水平，即分为开腹高二氧化碳组（OH）、开腹低二氧化碳组（OL）、腹腔镜高二氧化碳组（LH）、腹腔镜低二氧化碳组（LL）。采用相同麻醉诱导及维持方式。术前1 d，术后2 d、7 d行MMSE评分评定认知功能状态。结果4组病人术前MMSE评分差异无统计学意义。OH组与LH组术后2 d POCD发生率明显低于OL组与LL组（P＜0.05），术后7 d时差异无统计学意义（P＞0.05）；OH组与LH组术后2 d及7 d组间POCD发生率差异无统计学意义（P＞0.05），OL组与LL组术后2 d及7 d组间POCD发生率差异无统计学意义（P＞0.05）。结论术中维持较高动脉二氧化碳分压可减少老年人术后认知功能障碍的发生，开腹手术与腹腔镜手术相比术后认知功能障碍的发生情况无明显差异。“,”Objective To evaluate the effects of different surgical trauma and high/low PaCO2 on the occur-rence of postoperative cognitive dysfunction in gerontal patients undergoing radical nephrectomy. Methods We enrolled 67 patients between the ages of 60~75 with ASAⅠ~Ⅱundergoing laparoscopic or laparotomy radical nephrectomy. During the operation, two different levels of PaCO2 (45~48 mmHg, 35~38 mmHg) were main-tained randomly in any surgical method, which means all the patients were divided into 4 groups, laparoscopic/high group (LH), laparoscopic/low group (LL), laparotomy/high group (OH) and laparotomy/low group (OL). All the patients were used the same way of anesthesia induction and maintenance. The MMSE score was obtained on 1 day before operation and 2 and 7 days after operation. Results There was no signiifcant difference of the MMSE scores before operation between groups. 2 days after operation, the occurrence rates of POCD in groups of OH and LH were signiifcantly lower than the groups of OL and LL (P0.05). Also there was no signiifcant difference in the occurrence rate of POCD between group OL and LL on 2 and 7 days after operation (P>0.05). Conclusion Maintaining a higher level of PaCO2 during operation may decrease the occurrence rate of POCD in gerontal patients. We did not observe the difference of the occurrence rate of POCD between the two surgical methods.