Trendelenburg体位对腹腔镜手术患者视神经鞘直径的影响

Influence of Trendelenburg position on optic nerve sheath diameter in patients undergoing laparoscopic surgery

目的观察腹腔镜手术中常用头低脚高体位对患者视神经鞘直径(ONDS)的变化情况,并评估非陡峭Trendelenburge体位对患者颅内压的影响。方法选择2022年1月—11月于我院择期行腹腔镜下直肠癌、前列腺癌、膀胱癌根治性切除的患者51例,根据术中所用体位分为头低≤10°(A组)21例,头低11°~20°(B组)30例。所有患者均采用静吸复合麻醉,统一气腹压力13 mmHg,调节呼吸参数维持呼末二氧化碳分压35~40 mmHg。记录两组患者麻醉前(T0)、麻醉后(T1)、气腹头低位后5 min(T2)、1 h(T3)、2 h(T4)、结束气腹前(T5)、恢复体位放气后5 min(T6)双眼ONDS及患者的平均动脉压(MAP)、平台压(Pplat)和血二氧化碳分压(PCO_(2))。结果B组患者T2、T3时刻MAP高于A组,差异有统计学意义(P<0.05);B组患者T3、T4、T5时刻的Pplat高于A组,差异有统计学意义(P<0.05);各时点PCO_(2)组间比较差异无统计学意义(P>0.05);T3、T4、T5、T6,两组患者Pplat、PCO_(2)较T1、T2时刻有不同程度的增加(P<0.05)。两组患者T2~T5的ONDS较T0、T1时刻增加(P<0.05),且随着时间延长,呈不断上升趋势,直至T6时刻开始恢复。T2、T3、T4、T5、T6时刻,B组患者ONDS均高于A组患者(P<0.05)。B组患者的ONDS在T6时刻仍然高于T0时刻(P<0.05)。多因素线性回归分析结果显示,Trendelenburge体位的倾斜角与患者的ONDS存在关联(B=0.058,P=0.018)。结论腹腔镜手术中使用非陡峭的Trendelenburge体位,也可使患者视神经鞘直径增宽,且随着倾斜角度的增加,视神经鞘增宽愈明显,相应恢复时间亦延长。

Objective To observe the change of the diameter of optic nerve sheath(ONDS)in patients with common head low and foot high position during laparoscopic surgery,and evaluate the effect of non-steep Trendelenburge position on intracranial pressure.Methods Fifty-one patients scheduled for laparoscopic radical resection of rectal,prostate and bladder cancer,aged 18-80 years,with ASA gradeⅠ-Ⅲ,were divided 21 patients with a head low≤10 degree(group A)and 30 patients with a head low 10-20 degree(group B).All patients received general anesthesia and mechanical ventilation.CO2 pneumoperitoneum pressure maintained at 13 mmHg during the operation.Their optic nerve sheath diameters(ONDS),mean arterial pressure(MAP),airway plateau pressure(Pplat)and partial pressure of carbon dioxide(PaCO_(2))were recorded at seven predetermined time points:before anesthesia(T0),after anesthesia(T1),5 minutes(T2),1 hour(T3)and 2 hours(T4)after pneumoperitoneum and the trendelenburg position,before the release of the pneumoperitoneum(T5)and 5 minutes after resumption of position and deflation(T6).Results At T2-5,ONDS in both groups increased significantly(P<0.05),and continued to increase until recovered at T6.At T2-6,ONDS in group B were higher than in group A.In group B,T6 ONDS were higher than T0(P<0.05).The results of multiple linear regression analysis showed that the tilt angle of T-position was associated with patients’optic nerve sheath diameters(B=0.058,P=0.018).Conclusion The non-steep T position has an effect on the diameter of the optic nerve sheath in patients undergoing laparoscopic surgery,and as the tilt angle increases.The nerve sheath widens more significantly and the recovery time is prolonged.