不同机械通气模式对腹腔镜胃癌根治术患者术中颅内压的影响  

Effects of different mechanical ventilation modes on intraoperative intracranial pressure in patients undergoing laparoscopic radical gastrectomy

作　　者：汪懿[1] 李伟 文怀昌[1] 鲁美静[1] 金孝岠[1] 陈永权[1] WANG Yi;LI Wei;WEN Huaichang;LU Meijing;JIN Xiaoju;CHEN Yongquan(Department of Anesthesiology,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China;Department of Anesthesiology,Junan First People's Hospital)

机构地区：[1]皖南医学院弋矶山医院麻醉科,安徽芜湖241001 [2]莒南县第一人民医院麻醉科

出　　处：《沈阳医学院学报》2023年第1期34-38,共5页Journal of Shenyang Medical College

基　　金：皖南医学院中青年科研基金项目(No.WK202103)。

摘　　要：目的:应用超声测量视神经鞘直径(ONSD)观察容量控制通气(VCV)和压力控制通气(PCV)模式对腹腔镜胃癌根治术患者术中颅内压和术后认知功能的影响。方法:采用随机数字表法将2020年10月至2021年8月我院收治的80例择期行腹腔镜胃癌根治术患者随机分为VCV组(采用VCV通气)和PCV组(采用PCV通气),各40例;记录患者清醒时(T_(0))、机械通气后5 min(T_(1))、气腹后10 min(T_(2))、反Trendelenburg位后10 min(T_(3))和手术结束后5 min(T_(4))的呼气末二氧化碳分压(P_(ET)CO_(2))、平均动脉压(MAP)、心率(HR)和气道峰压(PPEAK),术中采用超声测量患者右眼ONSD。术前、术后3 d进行简易智能状态检查(mini-mental state examination,MMSE)。结果:2组患者在T_(2)、T_(3)时点P_(ET)CO_(2)、MAP值显著高于同组T_(0)、T_(1)时点(P<0.05),PCV组T_(2)、T_(3)时点P_(ET)CO_(2)、MAP值显著高于VCV组(P<0.05);2组患者在T_(2)、T_(3)时点PPEAK值显著高于同组T_(1)时点(P<0.05);T_(2)、T_(3)时点VCV组PPEAK值显著高于PCV组(P<0.05)。2组患者在T_(2)、T_(3)时间点ONSD测定值显著高于同组T_(0)、T_(1)时间点(P<0.05);T_(2)、T_(3)时PCV组ONSD测定值明显低于VCV组(P<0.05)。VCV组术后3 d时的MMSE测定值低于PCV组,但差异无统计学意义(P>0.05),且未达到诊断术后认知功能障碍的标准。结论:腹腔镜胃癌根治术中CO_(2)气腹增加了ONSD;与VCV通气模式相比,PCV通气模式可减轻腹腔镜手术导致的颅内压升高,但对术后认知功能的影响无明显差异。Objective:To observe the effects of volume controlled ventilation(VCV)and pressure controlled ventilation(PCV)on intraoperative intracranial pressure(ICP)by measuring optic nerve sheath diameter(ONSD)with ultrasound and postoperative cognitive function in patients undergoing laparoscopic radical gastrectomy Methods:A total of 80 patients undergoing laparoscopic radical gastrectomy in our hospital from Oct 2020 to Aug 2021 were randomly divided into VCV group(VCV ventilation)and PCV group(PCV ventilation),40 patients in each group.End expiratory partial pressure of carbon dioxide(P_(ET)CO_(2)),mean arterial pressure(MAP),heart rate(HR)and peak airway pressure(PPEAK)were recorded when the patient was awake(T_(0)),5 minutes after mechanical ventilation(T_(1)),10 minutes after pneumoperitoneum(T_(2)),10 minutes after anti-Trendelenburg position(T_(3))and 5 minutes after operation(T_(4)).ONSD of the patient’s right eye was measured by ultrasound during the operation.Mini mental state examination(MMSE)was performed before and 3 days after operation.Results:In the two groups,P_(ET)CO_(2)and MAP at T_(2)and T_(3)was significantly higher than that at T_(0)and T_(1)(P<0.05),P_(ET)CO_(2)and MAP in the PCV group at T_(2)and T_(3)was significantly higher than that of VCV group(P<0.05),and the PPEAKvalue at T_(2)and T_(3)was significantly higher than that at T_(1)(P<0.05).The PPEAKvalue of VCV group at T_(2)and T_(3)was significantly higher than that of PCV group(P<0.05).The ONSD values measured at T_(2)and T_(3)were significantly higher than those at T_(0)and T_(1)in the same group(P<0.05).At T_(2)and T_(3),the ONSD value in PCV group was significantly lower than that in VCV group(P<0.05).The measured value of MMSE at 3 days after operation in VCV group was lower than that in PCV group,but the difference was not statistically significant(P>0.05),and did not meet the criteria for diagnosis of POCD.Conclusions:CO_(2)pneumoperitoneum increases ONSD during laparoscopic radical gastrectomy.Compared with VCV ventilation mode,PCV

关 键 词：腹腔镜手术 胃癌根治术 颅内压 视神经鞘直径 

分 类 号：R614[医药卫生—麻醉学]