基于视神经鞘直径与眼球横径比值评价丙泊酚与地氟醚对妇科腹腔镜手术患者颅内压的影响

目的：应用超声测量视神经鞘直径（ONSD）与眼球横径（ETD）比值的方法评价丙泊酚与地氟醚对妇科腹腔镜患者颅内压的影响。方法：择期行妇科腹腔镜手术患者40例。随机分为丙泊酚组（P组）和地氟醚组（D组），每组20例。麻醉维持：P组静脉泵注丙泊酚，D组吸入地氟醚。两组均静脉泵注瑞芬太尼，按时追加罗库溴铵。使用容量控制通气模式。记录ETD，麻醉诱导后5 min（T0）、气腹开始后头低脚高位10 min（T1）、30 min（T2）、60 min（T3）和气腹结束恢复平卧位（T4）时的ONSD、心率（HR）、平均动脉压（MAP）、气道峰压（Ppeak）和呼气末二氧化碳分压（PETCO2）。计算不同时间点ONSD/ETD比值。结果：与T0时比较，T2-T3时两组ONSD值升高（P<0.05）；T2时D组ONSD值高于P组（P<0.05）。与T0时比较，T1时D组ONSD/ETD值明显升高（P<0.05）；T1-T4时D组ONSD/ETD值明显高于P组（P<0.05）。与T0时比较，T1-T4时两组MAP均明显升高（P<0.05）；T1-T3时两组Ppeak均明显升高（P<0.05）。T2-T3时D组MAP明显低于P组（P<0.05）。两组患者术后不良反应发生率相近。结论：在使用瑞芬太尼作为麻醉维持镇痛药物的同时，静脉注射丙泊酚或吸入地氟醚均可安全应用于妇科腹腔镜手术麻醉维持，与地氟醚相比，丙泊酚可一定程度减轻颅内压升高。

Evaluation of the effect of propofol and desflurane on intracranial pressure in patients undergoing gynecological laparoscopic surgery based on the ratio of diameter of optic nerve sheath to transverse diameter of eyeball

AIM: To evaluate the effects of propofol and desflurane on intracranial pressure in patients undergoing gynecological laparoscopic surgery by measuring the ratio of optic nerve sheath diameter (ONSD) to transverse diameter of the eye (ETD). METHODS: Forty patients, scheduled for elective gynecological endoscopic surgery, were randomly divided into propofol group (group P) and desflurane group (group D) (n=20). Anesthesia maintenance: propofol was injected intravenously in group P, desflurane was inhaled in group D. Remifentanil was injected intravenously and rocuronium was added on schedule. The patients were mechanically ventilated in volume-controlled mode. ETD was recorded after induction of anesthesia. ONSD, HR, MAP, peak airway pressure (Ppeak) and PETCO2 were recorded 5 min after induction of anesthesia (T0), 10 min (T1), 30 min (T2), 60 min (T3) after Trendelenburg position and after resuming the supine position (T4). ONSD/ETD values were calculated at different time points. RESULTS: Compared with T0, ONSD values of the two groups were increased at T2-T3 (P<0.05). ONSD value of group D was higher than that of group P at T2 (P<0.05). Compared with T0, the ratio of ONSD/ETD in group D was significantly increased at T1 (P<0.05). The ratio of ONSD/ETD in group D was significantly higher than that in group P at T1-T4 (P<0.05). Compared with T0, MAP in both groups was significantly increased at T1-T4 (P<0.05); Ppeak in both groups increased significantly at T1-T3 (P<0.05). MAP in group D was significantly lower than that in group P at T2-T3 (P<0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups. CONCLUSION: In addition to remifentanil as anesthesia maintenance analgesic, intravenous injection of propofol or inhalation of desflurane can be safely used in gynecological laparoscopic anesthesia maintenance. Compared with desflurane, propofol maintenance can relieve the increase of intracranial pressure.