Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
JAMA Surg. 2014 Apr;149(4):380-2. doi: 10.1001/jamasurg.2013.3024.
Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP.
Nine patients underwent insufflation with carbon dioxide (CO(2)) at pressures ranging from 8 to 15 mm Hg and ICP measured through a ventricular catheter. We used a paired t test to compare ICP with insufflation and desufflation. Linear regression correlated insufflation pressure with ICP. The mean ICP increase with 15-mm Hg insufflation is 7.2 (95% CI, 5.4-9.1 [P < .001]) cm H(2)O. The increase in ICP correlated with increasing insufflation pressure (P = .04). Maximum ICP recorded was 25 cm H(2)O.
Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure. The maximum ICP measured was a potentially dangerous 25 cm H(2)O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.
腹内压升高可能对颅内压（ICP）产生负面影响。关于腹腔镜检查对 ICP 影响的人体数据尚缺乏。我们回顾性地分析了脑室腹腔分流术的腹腔镜手术，以确定充气对 ICP 的影响。
9 例患者在 8 至 15mmHg 的压力下用二氧化碳（CO2）进行充气，通过脑室导管测量 ICP。我们使用配对 t 检验比较充气和放气时的 ICP。线性回归将充气压力与 ICP 相关联。15mmHg 充气时的平均 ICP 升高 7.2cmH2O（95%CI，5.4-9.1[P<0.001]）。ICP 的增加与充气压力的增加相关（P=0.04）。记录的最高 ICP 为 25cmH2O。
颅内压随着腹部充气而显著升高，并与腹腔镜充气压力相关。测量到的最高 ICP 为 25cmH2O，这是一个潜在危险的水平。对于基线 ICP 升高或头部创伤的患者，应谨慎使用腹腔镜检查。
