丙泊酚与七氟烷对腹腔镜前列腺癌手术患者视神经鞘直径的影响  

Effects of propofol and sevoflurane on optic nerve sheath diameter in patients undergoing laparoscopic prosta⁃tectomy

作　　者：应海峰 赵丹娟[1] 曹东航[1] 王明仓[1] YING Haifeng;ZHAO Danjuan;CAO Donghang(Department of Anesthesiology,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China)

机构地区：[1]浙江省台州医院麻醉科,浙江台州317000

出　　处：《全科医学临床与教育》2022年第6期525-527,533,共4页Clinical Education of General Practice

基　　金：台州市A类科技计划(21ywa56)。

摘　　要：目的探讨丙泊酚和七氟烷对腹腔镜前列腺癌根治术视神经鞘直径的影响。方法选择接受择期腹腔镜下前列腺癌根治手术的患者55例,按照随机数字表法分为丙泊酚组和七氟烷组。测定两组患者在麻醉诱导后10 min平卧位(T_(1))、头低位和气腹开始后15 min(T_(2))和60 min(T_(3))和气腹结束后10 min平卧位(T_(4))的视神经鞘直径,同时记录平均动脉压(MAP)和呼气末二氧化碳(EtCO_(2))的变化。结果两组患者在不同时间点的视神经鞘直径比较,差异均有统计学意义(F分别=38.15、35.32,P均<0.05)。丙泊酚组患者在T_(2)、T_(3)、T_(4)时的视神经鞘直径长于T_(1),差异均有统计学意义(t分别=4.56、5.58、3.07,P均<0.05);七氟烷组患者在T_(2)、T_(3)、T_(4)时的视神经鞘直径长于T_(1),差异均有统计学意义(t分别=5.33、9.23、4.47,P均<0.05)。丙泊酚组患者在T_(3)时视神经鞘直径小于七氟烷组,差异有统计学意义(t=3.60,P<0.05)。两组在T_(1)、T_(2)、T_(4)时的视神经鞘直径比较,差异均无统计学意义(t分别=0.61、0.27、1.00,P均>0.05)。两组患者在不同时间点上的MAP和EtCO_(2)比较,差异均无统计学意义(F分别=1.36、0.33,P均>0.05)。结论腹腔镜前列腺癌手术时,丙泊酚相比七氟烷可以减少头低位二氧化碳气腹期间引起的视神经鞘直径增加。Objective To explore the effects of propofol and sevoflurane on optic nerve sheath diameter(ONSD)in patients undergoing laparoscopic prostatectomy.Methods A total of 55 patients who underwent elective laparoscopic prostatectomy were randomly divided into propofol group and sevoflurane group.The time points of measuring the ONSD by ultrasound was 10 minutes after induction of anesthesia in supine position(T_(1)),15min(T_(2))and 60min(T_(3))after trendelenburg position and onset of pneumoperitoneum,10 minutes after the end of pneumoperitoneum in supine position(T_(4)).The mean arterial pressure(MAP)and EtCO_(2) were recorded at the same time.Results There was significant difference in the ONSD of the two groups at different time points(F=38.15,35.32,P<0.05).The ONSD at T_(2),T_(3)and T_(4)in the propofol group was longer than that at T_(1),and the differences were statistically significant(t=4.56,5.58,3.07,P<0.05).The ONSD at T_(2),T_(3)and T_(4)in the sevoflurane group was longer than that at T_(1),and the differences were statistically significant(t=5.33,9.23,4.47,P<0.05).The ONSD in the propofol group was shorter than that in the sevoflurane group at T_(3),and the difference was statistically significant(t=3.60,P<0.05).There was no significant difference in the ONSD between the two groups at T_(1),T_(2),and T_(4)(t=0.61,0.27,1.00,P>0.05).There was no significant difference in MAP and Et-CO_(2) of the two groups at different time points(F=1.36,0.33,P>0.05).Conclusion During laparoscopic prostatectomy,propofol inhibited the increasing of ONSD that induced by trendelenburg position and CO_(2) pneumoperitoneum when compared with sevoflurane.

关 键 词：视神经鞘 颅内压 气腹 头低位 

分 类 号：R614[医药卫生—麻醉学] R737.25[医药卫生—外科学]