超声视神经鞘直径评价气腹和Trendelenburg体位对妇科手术中颅内压的影响：一项前瞻性观察研究

IF 3.8 3区医学 Q1 SURGERY

Asian Journal of Surgery Pub Date : 2025-09-01 DOI:10.1016/j.asjsur.2025.04.036

Xiaoyun Ruan, Di Wu, Bingcheng Zhao, Huamin Liu, Chunhua Lu, Kexuan Liu, Wenting Chen

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引用次数: 0

摘要

背景先前的研究表明，气腹和Trendelenburg位可增加颅内压（ICP）。利用超声测量视神经鞘直径（ONSD）已成为一种简单、无创、可靠的侵入性ICP测量替代方法。方法本前瞻性研究纳入121例全麻妇科腹腔镜手术患者。术中不同时间点超声测量ONSD。术后1天内对所有患者进行头痛、恶心、呕吐、视力模糊和认知功能障碍的评估。结果在Trendelenburg体位建立气腹后，ONSD随着时间的推移而增加，在气腹释放并回到仰卧位时，ONSD显著降低（p < 0.05）。然而，在气腹释放1小时后，ONSD并没有恢复到基线水平并恢复到仰卧位（4.63 mm vs. 4.52 mm, p < 0.05）。术中不同的Trendelenburg角度显示ONSD随倾斜角度的增加有明显的上升趋势（p < 0.05）。ONSD≤5 mm患者术后头痛、恶心呕吐、视力模糊、认知功能障碍发生率高于ONSD≤5 mm患者（p < 0.05）。结论气腹联合Trendelenburg体位可显著增加术中ONSD。气腹持续时间越长，Trendelenburg位越陡，ONSD增加越显著。术后头痛、恶心呕吐、视力模糊和认知功能障碍与术中ONSD >； 5mm显著相关。

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Ultrasonographic optic nerve sheath diameter for assessing the effect of pneumoperitoneum and Trendelenburg position on intracranial pressure during gynecologic surgery: a prospective observational study

Background

Previous studies have shown that pneumoperitoneum and the Trendelenburg position can increase intracranial pressure (ICP). The optic nerve sheath diameter (ONSD) measurement using ultrasound has emerged as a simple, noninvasive, and reliable surrogate for invasive ICP measurement.

Methods

This prospective study enrolled 121 patients undergoing gynecologic laparoscopic surgery under general anesthesia. ONSD was measured using ultrasonography at different time points during surgery. All patients were assessed Postoperative headache, nausea and vomiting, blurred vision, and cognitive dysfunction within 1 day of recovery.

Results

After establishing the pneumoperitoneum in the Trendelenburg position, ONSD increased over time and decreased significantly upon release of the pneumoperitoneum and return to the supine position (p < 0 .05). However, ONSD did not return to baseline levels 1 h after the release of the pneumoperitoneum and return to the supine position (4.63 mm vs. 4.52 mm, p < 0.05). Different Trendelenburg angles during the surgeries revealed a significant upward trend in ONSD with increasing tilt angles (p < 0.05). Patients with ONSD > 5 mm experienced higher rates of postoperative headache, nausea and vomiting, blurred vision, and cognitive dysfunction than those with ONSD ≤ 5 mm (p < 0.05 respectively).

Conclusions

The combination of pneumoperitoneum and Trendelenburg position significantly increased ONSD during surgery. The longer the duration of the pneumoperitoneum and the steeper the Trendelenburg position, the more significant the increase in ONSD. Postoperative headache, nausea and vomiting, blurred vision, and cognitive dysfunction were significantly associated with an intraoperative ONSD > 5 mm.

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来源期刊

Asian Journal of Surgery 医学-外科

CiteScore

3.60

自引率

31.40%

发文量

1589

审稿时长

33 days

期刊介绍： Asian Journal of Surgery, launched in 1978, is the official peer-reviewed open access journal of the Asian Surgical Association, the Taiwan Robotic Surgery Association, and the Taiwan Society of Coloproctology. The Journal is published monthly by Elsevier and is indexed in SCIE, Medline, ScienceDirect, Scopus, Embase, Current Contents, PubMed, Current Abstracts, BioEngineering Abstracts, SIIC Data Bases, CAB Abstracts, and CAB Health. ASJSUR has a growing reputation as an important medium for the dissemination of cutting-edge developments in surgery and its related disciplines in the Asia-Pacific region and beyond. Studies on state-of-the-art surgical innovations across the entire spectrum of clinical and experimental surgery are particularly welcome. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance.