基于超声测量的视神经鞘直径与眼球横径比值评价腹腔镜妇科手术患者液体管理对颅内压的影响：一项随机对照试验。
Evaluation of the effect of fluid management on intracranial pressure in patients undergoing laparoscopic gynaecological surgery based on the ratio of the optic nerve sheath diameter to the eyeball transverse diameter as measured by ultrasound: a randomised controlled trial.
机构信息
Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical University, No.439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China.
出版信息
BMC Anesthesiol. 2024 Sep 7;24(1):319. doi: 10.1186/s12871-024-02683-7.
BACKGROUND
During gynecological laparoscopic surgery, pneumoperitoneum and the Trendelenburg position (TP) can lead to increased intracranial pressure (ICP). However, it remains unclear whether perioperative fluid therapy impacts ICP. The purpose of this research was to evaluate the impact of restrictive fluid (RF) therapy versus conventional fluid (CF) therapy on ICP in gynecological laparoscopic surgery patients by measuring the ratio of the optic nerve sheath diameter (ONSD) to the eyeball transverse diameter (ETD) using ultrasound.
METHODS
Sixty-four patients who were scheduled for laparoscopic gynecological surgery were randomly assigned to the CF group or the RF group. The main outcomes were differences in the ONSD/ETD ratios between the groups at predetermined time points. The secondary outcomes were intraoperative circulatory parameters (including mean arterial pressure, heart rate, and urine volume changes) and postoperative recovery indicators (including extubation time, length of post-anaesthesia care unit stay, postoperative complications, and length of hospital stay).
RESULTS
There were no statistically significant differences in the ONSD/ETD ratio and the ONSD over time between the two groups (all p > 0.05). From T2 to T4, the ONSD/ETD ratio and the ONSD in both groups were higher than T1 (all p < 0.001). From T1 to T2, the ONSD/ETD ratio in both groups increased by 14.3%. However, the extubation time in the RF group was shorter than in the CF group [median difference (95% CI) -11(-21 to -2) min, p = 0.027]. There were no differences in the other secondary outcomes.
CONCLUSION
In patients undergoing laparoscopic gynecological surgery, RF did not significantly lower the ONSD/ETD ratio but did shorten the tracheal extubation time, when compared to CF.
TRIAL REGISTRATION
ChiCTR2300079284. Registered on December 29, 2023.
背景
在妇科腹腔镜手术中，气腹和头低脚高位（TP）会导致颅内压（ICP）升高。然而，目前尚不清楚围手术期液体治疗是否会影响 ICP。本研究旨在通过超声测量视神经鞘直径（ONSD）与眼球横径（ETD）的比值，评估限制性液体（RF）治疗与常规液体（CF）治疗对妇科腹腔镜手术患者 ICP 的影响。
方法
将 64 例行腹腔镜妇科手术的患者随机分为 CF 组或 RF 组。主要结局为两组在预定时间点的 ONSD/ETD 比值差异。次要结局为术中循环参数（包括平均动脉压、心率和尿量变化）和术后恢复指标（包括拔管时间、麻醉后监护室停留时间、术后并发症和住院时间）。
结果
两组间 ONSD/ETD 比值和 ONSD 随时间的变化均无统计学差异（均 p>0.05）。从 T2 到 T4，两组的 ONSD/ETD 比值和 ONSD 均高于 T1（均 p<0.001）。从 T1 到 T2，两组的 ONSD/ETD 比值均增加了 14.3%。然而，RF 组的拔管时间短于 CF 组[中位数差值（95%CI）-11（-21 至-2）min，p=0.027]。其他次要结局无差异。
结论
与 CF 相比，在接受腹腔镜妇科手术的患者中，RF 并未显著降低 ONSD/ETD 比值，但缩短了气管拔管时间。
试验注册
ChiCTR2300079284. 于 2023 年 12 月 29 日注册。
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