呼气末正压通气对腹腔镜宫颈癌根治术患者眼压和视神经鞘直径的影响  

Effect of positive end-expiratory pressure on intraocular pressure and optic nerve sheath diameter in patients undergoing radical laparoscopic cervical cancer surgery

作　　者：王志刚[1] 石文汇 侯俊德[1] 赵永雷 陈永学[1] WANG Zhigang;SHI Wenhui;HOU Junde;ZHAO Yonglei;CHEN Yongxue(Department of Anesthesiology,Handan Central Hospital,Hebei Province,Handan 056008,China)

机构地区：[1]河北省邯郸市中心医院麻醉科,056008

出　　处：《临床麻醉学杂志》2020年第5期457-461,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察腹腔镜下宫颈癌根治术中,5 cmH2O的呼气末正压通气(PEEP)对患者眼内压(IOP)和颅内压的影响。方法选择我院择期行腹腔镜下宫颈癌根治术的患者60例,年龄45~65岁,BMI 20~25 kg/m2,ASAⅠ或Ⅱ级。采用随机数字表法分为两组,PEEP为5 cmH2O组(PEEP组)和无PEEP组(ZEEP组),每组30例。两组均采用静脉麻醉诱导气管插管,诱导完成机械通气后,PEEP组设置呼气末正压为5 cmH2O,ZEEP组呼气末正压设置为0。记录麻醉诱导前(T0)、麻醉后气腹前10 min平卧位(T1)、气腹Trendelenburg体位后5 min(T2)、30 min(T3)、恢复平卧位气腹消失后(T4)和术后30 min(T5)时的IOP、视神经鞘直径(ONSD)、PaO2、PaCO2,同时记录T1-T4时肺动态顺应性(Cdyn)、气道峰压(Ppeek)和T0-T5时HR和MAP。结果与T0时比较,T1时两组IOP明显降低(P<0.01),T2-T3时IOP明显延长(P<0.01),T2-T3时ZEEP组ONSD明显延长(P<0.01),T3时PEEP组ONSD明显延长(P<0.05)。T1-T4时PEEP组PaO2、Cdyn明显高于ZEEP组(P<0.05)。T1时PEEP组Ppeek明显高于ZEEP组(P<0.05)。结论在腹腔镜宫颈癌根治术手术中,气腹和Trendelenburg体位下应用5 cmH2O的PEEP改善患者氧合的同时不引起IOP和颅内压的增高。Objective To observe the effect of 5 cmH 2O positive end-expiratory pressure(PEEP)on intraocular pressure and intracranial pressure in patients undergoing laparoscopic radical cervical cancer surgery.Methods Sixty patients undergoing elective laparoscopic radical ectomy of cervical cancer,aged 45-65 years,BMI 20-25 kg/m 2,falling into ASA physical statusⅠorⅡ,were randomly divided into two groups:the group with positive end-expiratory pressure(group PEEP)and the group without positive end-expiratory pressure(group ZEEP),with 30 patients in each group.Intratracheal intubation was induced by intravenous anesthesia.After induction of mechanical ventilation,the positive end expiratory pressure in group PEEP was set to 5 cmH 2O,and the positive end expiratory pressure in group ZEEP was set to zero.Intraocular(IOP),optic nerve canal diameter(ONSD),PaO 2 and PaCO 2 were measured at the moment before induction(T 0),10 min after induction of general anesthesia with the supine position before CO 2 insufflation(T 1),5 min(T 2)and 30 min(T 3)after pneumoperitoneum Trendelenburg position with Trendelenburg position,after desufflation of pneumoperitoneum and restoration of the supine position(T 4),and 30 min after surgery(T 5).Meanwhile,the T 1-T 4 dynamic lung compliance(Cdyn),the airway peak pressure(Ppeak)and T 0-T 5 hemodynamic parameters HR,MAP were recorded.Results Compared with T 0,IOP significantly decreased in the two groups at T 1(P<0.01),IOP significantly increased at T 2-T 3(P<0.01),ONSD significantly increased at T 2-T 3 in group ZEEP(P<0.01),and ONSD significantly increased at T 3 in group PEEP(P<0.05).PaO 2 and Cdyn in group PEEP at T 1-T 4 were significantly higher than those in group ZEEP(P<0.05).Ppeak in group PEEP at T 1 was significantly higher than that in group ZEEP(P<0.05).There were no significant differences in IOP,ONSD,PaCO 2,HR and MAP between the two groups at different time points.Conclusion During laparoscopic radical resection of cervical cancer,administrated with 5 cmH 2O of PEEP under pneumo

关 键 词：眼内压 颅内压 呼气末正压 Trendelenburg体位 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]