胆囊腹腔镜手术中颈静脉球压力及相关因素对颅内压的影响

The effects of jugular bulb pressure and associated factors on intracranial pressure during cholecystic laparoscopic surgery

目的探讨胆囊腹腔镜手术颈静脉球压力(jugular buln pressure,JBP)等的变化及可能对颅内压(ICP)产生的影响。方法选择32例ASAⅠ～Ⅱ级胆囊腹腔镜手术患者,在局麻下行右颈内静脉逆行穿刺置管达颈静脉球,以丙泊酚、阿曲库铵及瑞芬太尼行气管内全麻,潮气量(V_T)8 ml/kg,呼吸频率(RR)16次/分,术中维持通气条件不变。检测气腹前、气腹与头高位即刻及气腹后10、30、60 min时的JBP、气道峰压(PIP)、平均动脉压(MAP)及呼气末二氧化碳分压(P_(ET)CO_2)等。并对JBP和PIP均数进行相关分析。结果气腹后JBP、PIP、MAP及P_(ET)CO_2均明显升高(P＜0．01),JBP及PIP之均数呈安全正相关。结论头高位气腹条件下PIP及JBP明显增高,颅内静脉回流受阻,可引起ICP增高。

Objective： To investigate the influences of jugular bulb pressure （JBP） and associated factors on intracranial pressure （ICP） during cholecystic surgery. Methods： 32ASA grade Ⅰ - Ⅱ patients undergoing cholecystic laparoscopic surgery were selected. Anesthesia was induced and maintained with propofol remifentanil and aracurium. The JBP, peak inspiratory pressure （PIP） and PETCO：2 were measured before pneumoperitonemn （PP）, PP and the head-up moment, 10, 30 and 60 minutes after PP respectively. Results： Compared with those before PP, the JBP, PIP and PETCO2 were increased significantly after PP （P 〈0. 01 ）. The correlation between JBP and PIP was significant. Conclusion： ICP as indicated by an increase of JBP is elevated during cbolecystic laparoscopic surgery.