颈部内镜手术充二氧化碳和氦气对颅内压的影响

The effect of cervical gas insufflation on intracranial pressure during endoscopic neck surgery

目的通过兔颈部灌注二氧化碳(CO2)和氦气(He),检测不同压力和灌注持续时间对于颅内压的影响。方法将15只新西兰兔随机分成5组。分别为5mmHgCO2组、10mmHgCO2组、15mmHgCO2组、15mmHgHe组及颈部不充气对照组。分别在充气前,充气后45分钟、90分钟和放气后30分钟记录动脉血PaCO2、pH值及颅内压(intracranialpressure,ICP)。结果5mmHgCO2组对各项检测指标均没有显著影响。颈部灌注CO2压力为10mmHg组在45分钟和90分钟时PaCO2有显著性升高(P<0.05)。颈部灌注CO2压力为15mmHg组在45分钟和90分钟时PaCO2、pH及ICP有显著性变化(P<0.05),放气后30分钟未回落到基线水平。颈部灌注He压力为15mmHg在45分钟和90分钟时ICP显著升高(P<0.05),放气后30分钟均回落到基线水平。He不引起高碳酸血症。结论在颈部内镜手术中将CO2和He充气压力控制在10mmHg对颅内压无明显影响。

OBJECTIVE Carbon dioxide and helium were insufflated into the neck of rabbit to investigate the effect of different levels of insufflation pressure and duration on intracranial pressure. METHODS Fifteen New Zealand rabbits were randomly divided into 5 groups： 5 mmHg CO2, 10 mmHg CO2, 15 mmHg CO2, 15 mmHg He and 0 mmHg group. Arterial partial pressure of CO2 （PaCO2）, pH and intracranial pressure （ICP） were measured at baseline, 45 min and 90 min after gas insufflation and 30 min after desufflation. RESULTS Insufflation of CO2 at 5mmHg did not have any significant effect on the parameters. PaCO2 increased significantly 45 min and 90 min after CO2 insuffiation at 10mmHg （P〈0.05）. Marked changes in PaCO2, pH and ICP occurred 45 min and 90 min after CO2 insuffiation at 15mmHg （P〈0.05）, and the parameters did not return to baseline 30 min after desuffiation. In animals receiving He insufflation at 15mmHg, ICP elevated significantly after 45 min and 90 min （P〈0.05）, and retumed to baseline 30 min after desufflation. Animals receiving He insuffiation did not experience hypercapnia. CONCLUSION Intracranial pressure cannot be influenced by carbon dioxide and Helium insufflation for endoscopic neck surgery below 10mmHg.