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体外循环和视神经超声:一项初步研究。

Extracorporeal Circulation and Optic Nerve Ultrasound: A Pilot Study.

机构信息

Department of Anesthesiology and Reanimation, Kastamonu University Faculty of Medicine, 37150 Kastamonu, Turkey.

出版信息

Medicina (Kaunas). 2023 Feb 23;59(3):445. doi: 10.3390/medicina59030445.

Abstract

: Cardiopulmonary bypass (CPB) is an extracorporeal circuit that provides surgical access to an immobile and bloodless area, allowing for technical and procedural advances in cardiothoracic surgery. CBP can alter the integrity of the blood-brain barrier and cause changes in intracranial pressure (ICP) postoperatively. Optical nerve sheath diameter (ONSD) measurement is among the alternative non-invasive methods for ICP monitoring. In this study, we aimed to evaluate the optic nerve sheath diameter measurements under the guidance of ultrasonography for ICP changes during the extracorporeal circulation process. : The study population included 21 patients over 18 years of age who required extracorporeal circulation. Demographic data of the patients, such as age, gender, comorbidity, American Society of Anesthesiologists (ASA) classification and reason for operation (coronary artery disease or mitral or aortic valve disease) were recorded. The ONSD was measured and evaluated before the extracorporeal circulation (first time) and at the 30th minute (second time), 60th minute (third time) and 90th minute (fourth time) of the extracorporeal circulation. Non-invasive ICP (ICP ONSD) values were calculated based on the ONSD values found. : The mean ONSD values measured before the extracorporeal circulation of the patients were found to be 4.13 mm (3.8-4.6) for the right eye and 4.36 mm (4.1-4.7) for the left eye. Calculated nICPONSD values of 11.0 mm Hg (1.0-21.0) for the right eye and 10.89 mm Hg (1.0-21.0) for the left eye were found. It was observed that there was a significant increase in the ONSD and nlCPONSD values recorded during the extracorporeal circulation of all patients compared to the baseline values ( < 0.005). : During extracorporeal circulation, ultrasound-guided ONSD measurement is an easy, inexpensive and low-complication method that can be performed at the bedside during the operation to monitor ICP changes.

摘要

体外循环(CPB)是一种体外循环回路,为无法移动和无血的区域提供手术通道,从而使心胸外科手术技术和程序得以发展。CPB 可改变血脑屏障的完整性并导致术后颅内压(ICP)改变。视神经鞘直径(ONSD)测量是 ICP 监测的替代非侵入性方法之一。在这项研究中,我们旨在评估超声引导下 ONSD 测量在体外循环过程中 ICP 变化的价值。

研究人群包括 21 名年龄在 18 岁以上需要体外循环的患者。记录了患者的人口统计学数据,如年龄、性别、合并症、美国麻醉师协会(ASA)分类和手术原因(冠状动脉疾病或二尖瓣或主动脉瓣疾病)。在体外循环前(第一次)和体外循环 30 分钟(第二次)、60 分钟(第三次)和 90 分钟(第四次)时测量并评估 ONSD。根据所发现的 ONSD 值计算非侵入性 ICP(ICP ONSD)值。

患者体外循环前测量的平均 ONSD 值为右眼 4.13 毫米(3.8-4.6),左眼 4.36 毫米(4.1-4.7)。右眼 nICPONSD 值为 11.0 毫米汞柱(1.0-21.0),左眼 nICPONSD 值为 10.89 毫米汞柱(1.0-21.0)。与基线值相比,所有患者在体外循环过程中记录的 ONSD 和 nICPONSD 值均显著增加(<0.005)。

在体外循环过程中,超声引导下的 ONSD 测量是一种简单、经济且并发症少的方法,可以在手术床边进行,以监测 ICP 变化。

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