呼气末正压对机器人辅助腹腔镜前列腺切除术中作为颅内压替代指标的超声视神经鞘直径的影响：一项随机对照试验。
Effect of Positive End-Expiratory Pressure on the Sonographic Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure during Robot-Assisted Laparoscopic Prostatectomy: A Randomized Controlled Trial.
作者信息
Chin Ji-Hyun, Kim Wook-Jong, Lee Joonho, Han Yun A, Lim Jinwook, Hwang Jai-Hyun, Cho Seong-Sik, Kim Young-Kug
机构信息
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Occupational and Environmental Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea.
出版信息
PLoS One. 2017 Jan 20;12(1):e0170369. doi: 10.1371/journal.pone.0170369. eCollection 2017.
BACKGROUND
Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy.
METHODS
After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups.
RESULTS
Optic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6-4.9) mm vs 4.8 (4.7-5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3-4.6) mm vs 4.5 (4.4-4.6) mm, P = 0.733].
CONCLUSIONS
An 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy.
TRIAL REGISTRATION
ClinicalTrial.gov NCT02516566.
背景
呼气末正压（PEEP）可升高颅内压。气腹和头低脚高位与颅内压升高有关。我们研究了在接受机器人辅助腹腔镜前列腺切除术的患者中，在气腹联合头低脚高位期间，PEEP通气是否会额外影响超声测量的视神经鞘直径，以此作为颅内压的替代指标。
方法
麻醉诱导后，38例患者被随机分配至低潮气量通气（8 ml/kg）且无PEEP组（呼气末零压力[ZEEP]组，n = 19）或低潮气量通气且PEEP为8 cmH₂O组（PEEP组，n = 19）。在皮肤切开前、气腹和头低脚高位后5分钟及30分钟以及手术结束时测量超声视神经鞘直径。研究终点是ZEEP组和PEEP组在气腹和头低脚高位后5分钟时超声视神经鞘直径的差异。
结果
气腹和头低脚高位后5分钟时，两组间视神经鞘直径无显著差异[最小二乘均值（95%置信区间）；4.8（4.6 - 4.9）mm对4.8（4.7 - 5.0）mm，P = 0.618]。气腹和头低脚高位后30分钟时，两组间视神经鞘直径也无差异[最小二乘均值（95%置信区间）；4.5（4.3 - 4.6）mm对4.5（4.4 - 4.6）mm，P = 0.733]。
结论
在低潮气量通气下应用8 cmH₂O的PEEP，在气腹联合极度头低脚高位期间不会导致视神经鞘直径增加，这表明在机器人辅助腹腔镜前列腺切除术中，PEEP可能对颅内压没有不利影响。
试验注册
ClinicalTrial.gov NCT02516566
Zotero 插件