不同呼气末正压对腹膜后腹腔镜手术患者视神经鞘直径的影响  

Effect of different positive end-expiratory pressure on optic nerve sheath diameter in patients undergoing retroperitoneal laparoscopic surgery

作　　者：陈晓龙 谈世刚 甘国胜 CHEN Xiaolong;TAN Shigang;GAN Guosheng(Department of Anesthesiology,General Hospital of PLA Central Theater Command,Wuhan,Hubei 430070,China)

机构地区：[1]中国人民解放军中部战区总医院麻醉科,武汉430070

出　　处：《重庆医学》2022年第21期3709-3713,3720,共6页Chongqing medicine

摘　　要：目的观察不同呼气末正压通气(PEEP)对腹膜后腹腔镜手术患者视神经鞘直径(ONSD)的影响。方法选择该院择期于全身麻醉下行腹膜后腹腔镜手术患者40例,采用随机数字表法分为2组:呼气末正压通气(PEEP)0 cm H_(2)O(C组)和PEEP 5 cm H_(2)O(P组),每组20例。麻醉诱导后行机械通气,C组设置PEEP为0 cm H_(2)O,P组设置呼气末正压为5 cm H_(2)O。记录入室时(T_(0))、侧卧折刀位5 min(T_(1))、气腹后10 min(T_(2))、气腹后30 min(T_(3))、手术结束恢复体位后10 min(T_(4))5个时间点右眼ONSD;在各时间点行动脉血气分析并记录动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2)),通过动脉血气结果计算各时间点氧合指数(OI);记录T_(1)~T_(4)时气道峰压(Ppeak);记录患者术后7 d内恶心呕吐、眼痛、头痛、肺部并发症的发生情况。结果与T_(0)时比较,2组T_(2)、T_(3)时右眼ONSD明显增加(P<0.05);与T_(1)时比较,C组T_(3)、T_(4)时OI明显降低(P<0.05);与T_(1)时比较,2组T_(2)~T_(4)时PaCO_(2)明显升高(P<0.05);与T_(1)时比较,2组T_(2)、T_(3) Ppeak明显升高(P<0.05);与C组比较,P组T_(2)~T_(4)时OI明显升高,T_(2)、T_(3)时Ppeak明显升高(P<0.05)。2组患者术后7 d恶心呕吐、眼痛、头痛、肺部并发症等比较差异无统计学意义(P>0.05)。结论在腹膜后腹腔镜手术中,侧卧折刀位和应用PEEP 5 cm H_(2)O肺保护性通气策略可以改善患者氧合同时对患者ONSD无明显影响。Objective To observe the effect of different positive end-expiratory pressure(PEEP)on optic nerve sheath diameter(ONSD)in the patients undergoing retroperitoneal laparoscopic surgery.Methods Forty patients undergoing elective retroperitoneal laparoscopic surgery under general anesthesia in this hospital were selected and divided into the two groups:PEEP 0 cm H_(2)O(group C)and PEEP 5 cm H_(2)O(group P)by the random number table methods,20 cases in each group.The mechanical ventilation was performed after anesthesia induction.PEEP was set at 0 cm H_(2)O in group C and 5 cm H_(2)O in group P.ONSD of the right eye was recorded at five time points:entering the operation room(T_(0)),5 min in the folding knife position(T_(1)),10 min after pneumoperitoneum(T_(2)),30 min after pneumoperitoneum(T_(3)),and 10 min after the recovery position after surgery(T_(4)).The arterial blood gas was performed at each time point.The partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were recorded at each time point.The oxygenation index(OI)at each time point was calculated based on arterial blood gas results.The Ppeak from T_(1)-T_(4) was recorded;the occurrence situation of nausea and vomiting,eye pain,headache and pulmonary complications within 7 d after surgery was recorded.Results Compared with T_(0),ONSD on the right side at T_(2)-T_(3) was significantly increased(P<0.05);compared with T_(1),OI at T_(3)-T_(4) in the group C was significantly decreased(P<0.05);compared with T_(1),PaCO_(2) of the two group,at T_(2)-T_(4) was significantly increased(P<0.05).Compared with T_(1),Ppeak of the two groups at T_(2),T_(3) was significantly increased(P<0.05);compared with group C,OI at T_(2)-T_(2) in the group P was significantly higher than that in the group C,and Ppeak at T_(2)-T_(3) in the group P was higher than that in the group C(P<0.05).The complications of nausea and vomiting,eye pain,headache and pulmonary complications within postoperative 7 d has no significant different between two groups(P>0.05).C

关 键 词：侧卧折刀位 腹膜后腹腔镜手术 视神经鞘直径 呼气末正压 保护性通气 

分 类 号：R614[医药卫生—麻醉学]