不同气腹压力对腹膜后腹腔镜手术患者视神经鞘直径的影响  

Effect of Different Pneumoperitoneum Pressure on the Diameter of Optic Nerve Sheath in Patients Undergoing Retroperitoneal Laparoscopic Surgery

作　　者：谈世刚 夏中元[1] Tan Shigang;Xia Zhongyuan(Department of Anesthesiology,Wuhan University People′s Hospital,Hubei 430070,China)

机构地区：[1]武汉大学人民医院麻醉科,430070

出　　处：《医学研究杂志》2021年第5期100-103,共4页Journal of Medical Research

摘　　要：目的观察不同气腹压力对侧卧折刀位腹膜后腹腔镜手术患者视神经鞘直径的影响。方法选择笔者医院择期于全身麻醉下行腹膜后腹腔镜手术患者60例,采用数字表法随机分为两组(n=30),即气腹压力为12mmHg(1mmHg=0.133kPa,A组)和气腹压力为15mmHg(B组)。两组患者麻醉诱导和维持药物种类和剂量一致,麻醉诱导后气管插管行机械通气。记录气管插管后1min(T_(0))、侧卧折刀位即刻(T_(1))、气腹后10min(T_(2))、气腹后30min(T_(3))、气腹后60min(T_(4))、手术结束后10min(T_(5))6个时间点MAP、HR、PetCO_(2)、右眼ONSD,同时记录术后患者恶心、呕吐、眼痛、头痛等并发症的发生情况。结果与T 0时比较,T_(3~4)时两组MAP、HR、PetCO_(2)、右侧ONSD均明显升高(P<0.05);与A组比较,T_(3~4)时B组HR、PetCO_(2)、右侧ONSD明显高于A组,T_(2)~4时B组MAP明显高于A组(P<0.05)。结论侧卧折刀位腹膜后腹腔镜手术中不同气腹压力12mmHg和15mmHg均可增加患者视神经鞘直径,但15mmHg气腹压力对患者视神经鞘直径的影响更大。Objective To observe the effect of different pneumoperitoneum pressure on the diameter of optic nerve sheath in patients undergoing retroperitoneal laparoscopic surgery with lateral decubitus knife.Methods Sixty cases of patients undergoing retroperitoneal laparoscopic surgery under general anesthesia in our hospital were selected and divided into two groups(n=30)by random number table method:pneumoperitoneum pressure was 12mmHg(group A)and pneumoperitoneum pressure was 15mmHg(group B).The two groups of patients were anesthetized and maintained the same drug type and dose.After anesthesia induction,endotracheal intubation was performed for mechanical ventilation.MAP,HR,PetCO_(2) right eye optic nerve sheath diameter(ONSD)were recorded 1min after endotracheal intubation(T_(0)),side knife immediately(T_(1)),10min after pneumoperitoneum(T_(2)),30min after pneumoperitoneum(T_(3)),60min after pneumoperitoneum(T_(4)),after the surgery for 10min(T_(5)).At the same time,postoperative patients with nausea and vomiting,the occurrence of complications such as eye irritation,headache were recorded.Results Compared with T_(0),MAP,HR,PetCO_(2)and right ONSD were significantly increased in T_(3-4) groups(P<0.05).Compared with group A,HR,PetCO_(2)and right ONSD in Group B were significantly higher at T 3-4 than group A,and MAP in group B was significantly higher at T 2-4 than group A(P<0.05).Conclusion During retroperitoneal laparoscopic surgery,different pneumoperitoneum pressures of 12mmHg and 15mmHg can increase the diameter of optic nerve sheath in patients,but 15mmHg pneumoperitoneum pressure has a greater impact on the diameter of optic nerve sheath.

关 键 词：气腹压力 侧卧折刀位 腹膜后腹腔镜手术 视神经鞘直径 

分 类 号：R614[医药卫生—麻醉学]