Rubino F, Pamoukian V N, Zhu J F, Deutsch H, Inabnet W B, Gagner M
Division of Laparoscopic Surgery, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Surgery. 2000 Dec;128(6):1035-42. doi: 10.1067/msy.2000.110238.
Endoscopic endocrine neck surgery requires insufflation with carbon dioxide (CO(2)) at 10 to 15 mm Hg, which may decrease the cerebral venous return and increase intracranial pressure. This study evaluated the effect of CO(2) neck insufflation on intracranial pressure (ICP) and hemodynamic parameters.
Fifteen pigs underwent endoscopic thyroid dissection. Insufflation was performed with CO(2) at 0 (sham), 10, 15, and 20 mm Hg and with helium at 20 mm Hg with 3 pigs in each group. ICP, mean arterial pressure, central venous pressure (CVP), cardiac output, and blood gas were measured at baseline, 30, 60, and 120 minutes.
There were no differences in mean ICP between the sham group and CO(2) insufflation at 10 mm Hg. Mean ICP increased significantly with CO(2) at 15 and 20 mm Hg and with helium at 20 mm Hg. A significant increase in CVP occurred in pigs operated with CO(2) at 20 mm Hg. We observed jugular vein collapse under all insufflation pressures; however, pigs operated at 10 mm Hg were able to maintain an intermittent blood flow.
A severe increase in ICP occurs with insufflation pressures higher than 15 mm Hg, possibly as a result of decreased cervical venous blood flow. Carbon dioxide insufflation up to 10 mm Hg does not alter ICP and is recommended for clinical application in endoscopic neck surgery.
内镜下颈部内分泌手术需要以10至15毫米汞柱的压力注入二氧化碳（CO₂），这可能会减少脑静脉回流并增加颅内压。本研究评估了颈部CO₂注入对颅内压（ICP）和血流动力学参数的影响。
15头猪接受了内镜下甲状腺切除术。每组3头猪，分别以0（假手术）、10、15和20毫米汞柱的压力注入CO₂，以及以20毫米汞柱的压力注入氦气。在基线、30、60和120分钟时测量ICP、平均动脉压、中心静脉压（CVP）、心输出量和血气。
假手术组与10毫米汞柱CO₂注入组之间的平均ICP无差异。15和20毫米汞柱的CO₂注入以及20毫米汞柱的氦气注入使平均ICP显著升高。在以20毫米汞柱CO₂进行手术的猪中，CVP显著升高。在所有注入压力下均观察到颈静脉塌陷；然而，在10毫米汞柱压力下进行手术的猪能够维持间歇性血流。
注入压力高于15毫米汞柱时ICP会显著升高，可能是由于颈静脉血流减少所致。高达10毫米汞柱的CO₂注入不会改变ICP，建议在内镜下颈部手术中临床应用。
