丙泊酚与七氟醚对妇科腹腔镜患者视神经鞘直径的影响

Effects of propofol and sevoflurane on optic nerve sheath diameter in patients undergoing gynecological laparoscopic surgery

目的应用超声测量视神经鞘直径(ONSD)方法评价丙泊酚与七氟醚对妇科腹腔镜患者颅内压的影响。方法选择择期行妇科腹腔镜手术患者40例,年龄20~60岁,BMI 18~27 kg/m^2,ASAⅠ或Ⅱ级。采用随机数字表法分为丙泊酚组(P组)和七氟醚组(S组),每组20例。麻醉维持:P组静脉泵注丙泊酚4~12 mg·kg-1·h-1,S组吸入1~2%七氟醚。使用容量控制模式,V T 6~8 ml/kg,FiO 250%,I∶E 1∶2,RR 12~20次/分。记录麻醉诱导后5 min(T 0)、气腹开始后头低脚高位5 min(T 1)、气腹开始后头低脚高位30 min(T 2)、气腹开始后头低脚高位60 min(T 3)时的HR、MAP、气道峰压(Peak)、气道平台压(Plat)、P ET CO 2和ONSD。结果与T 0时比较,T 1-T 3时P组MAP明显降低,T 2-T 3时S组MAP明显降低(P<0.05),T 1-T 3时两组Peak、Plat明显升高(P<0.05),T 1-T 3时两组ONSD明显升高(P<0.05)。T 1时P组MAP明显低于S组(P<0.05)。T 3时P组ONSD明显低于S组(P<0.05)。结论在妇科腹腔镜手术中,与单纯使用七氟醚比较,应用丙泊酚维持可一定程度减轻颅内压的升高。

Objective To evaluate the effect of propofol and sevoflurane on intracranial pressure in patients undergoing gynecological laparoscopic surgery by ultrasound measurement of optic nerve sheath diameter(ONSD).Methods Forty patients,aged 20-60 years,BMI 18-27 kg/m^2,ASA physical statusⅠ-Ⅱ,scheduled for elective gynecological endoscopic surgery,were divided into two groups(n=20)by random number table method:propofol group(group P)and sevoflurane group(group S).Anesthesia maintenance:4-12 mg·kg-1·h-1 of propofol was injected intravenously in group P,1%-2%sevoflurane was inhaled in group S.The patients were mechanically ventilated in volume-controlled mode,with V T 6-8 ml/kg,FiO 250%,I∶E 1∶2 and RR 12-20 times/min.HR,MAP,Peak,Plat,P ET CO 2,and ONSD were recorded at the following four time points:5 min after anesthesia induction(T 0),5 min,30 min and 60 min of head-down tilt at the beginning of pneumoperitoneum(T 1-T 3).Results Compared with T 0,MAP in Group P decreased significantly at T 1-T 3,MAP in group S decreased significantly at T 2-T 3(P<0.05),Peak and Plat increased significantly at T 1-T 3(P<0.05),and ONSD increased significantly at T 1-T 3(P<0.05).MAP in group P was significantly lower than that in group S at T 1(P<0.05).ONSD in Group P was significantly lower than that in group S at T 3(P<0.05).Conclusion Compared with sevoflurane alone,propofol maintenance can relieve the increase of intracranial pressure in gynecologic laparoscopic surgery.