腹腔镜妇科肿瘤根治术中并发脑水肿的评估:超声法测定视神经鞘直径

Assessment of brain edema occurrence during laparoscopic radical resection of gynecological tumor:measurement of optic nerve sheath diameter by ultrasound method

目的通过超声法测定视神经鞘直径(ONSD),评估腹腔镜妇科肿瘤根治术中是否并发脑水肿。方法择期行腹腔镜妇科肿瘤根治术患者40例,年龄35~64岁,BMI 18.5~25.0 kg/m^2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=20):高渗氯化钠羟乙基淀粉40注射液(HSH40)治疗性诊断组(H组)和生理盐水对照组(N组),分别于气腹头低位150 min时持续输注HSH405 ml/kg和等容量生理盐水30 min。麻醉诱导后5 min(T0)、气腹头低位10、60、120、180 min(T1-4)和放气腹平卧位10 min(T5)时,采用超声法测量双侧ONSD,观察治疗性诊断试验前后颅内压增高的发生情况以及治疗性诊断试验的效果。结果与N组比较,H组T4,5时ONSD缩短(P<0.05);与T3时比较,H组T4时ONSD缩短(P<0.05)。2组患者治疗性诊断试验前颅内压增高发生率差异无统计学意义(P>0.05)。H组治疗性诊断试验的有效率为94%。结论腹腔镜妇科肿瘤根治术因素可诱发患者脑水肿,应采取预防措施。

Objective To assess whether brain edema occurred during laparoscopic radical resection of gynecological tumor through measurement of optic nerve sheath diameter(ONSD)by ultrasound.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 35-64 yr,with body mass index of 18.5-25.0 kg/m^2,scheduled for elective laparoscopic radical resection of gynecologic tumor,were divided into 2 groups(n=20 each)using a random number table method:hypertonic sodium chloride hydroxyethyl starch 40 injection(HSH40)therapeutic diagnosis group(group H)and normal saline control group(group N).HSH405ml/kg was continuously infused for 30 min starting from 150 min after Trendelenburg position and CO2 pneumoperitoneum in group H,and the equal volume of normal saline was given instead in group N.The bilateral ONSDs were measured using ultrasound at 5 min after anesthesia induction(T0),10,60,120 and 180 min after Trendelenburg position and CO2 pneumoperitoneum(T1-4)and 10 min of supine position after deflation(T5).The occurrence of increased intracranial pressure before and after therapeutic diagnostic test and efficacy of therapeutic diagnostic test were observed.Results The ONSD was significantly shorter at T4-5 in group H than in group N(P<0.05).The ONSD was significantly shorter at T4-5 than at T3 in group H(P<0.05).There was no significant difference in the incidence of increased intracranial pressure before therapeutic diagnostic test between the two groups(P>0.05).The effective rate of therapeutic diagnostic test was 94%in group H(P<0.05).Conclusion Laparoscopic radical resection of gynecologic tumor factor can induce brain edema,and preventive measures should be taken.