Kazancıoğlu Leyla, Batçık Şule
Department of Anesthesiology and Reanimation, Faculty of Medicine, Recep Tayyip Erdoğan University, 53020 Rize, Türkiye.
Medicina (Kaunas). 2025 May 9;61(5):870. doi: 10.3390/medicina61050870.
In coronary artery bypass grafting (CABG) surgeries, monitoring intracranial pressure (ICP) is crucial due to neurological risks. Although pulsatile flow (PF) during cardiopulmonary bypass (CPB) is considered more physiological than non-pulsatile flow (NPF), its impact on ICP remains unclear. This study aimed to compare preoperative and postoperative optic nerve sheath diameter (ONSD) measurements between PF and NPF techniques to evaluate their effect on ICP changes. Sixty patients undergoing elective CABG (aged 45-75 years, ASA II-III-IV) were enrolled and divided into two groups depending on the cardiopulmonary bypass technique determined by the surgeon: PF (Group P, n = 30) and NPF (Group NP, n = 30). ONSD measurements were performed with ultrasound before surgery (Tpreop) and after surgery (Tpostop). Hemodynamic parameters and jugular and carotid vessel diameters were also recorded. Statistical analysis included -tests, Mann-Whitney U-tests, chi-square tests, and Pearson correlation. Both groups demonstrated significant increases in ONSD postoperatively compared to preoperative values ( < 0.001). However, no statistically significant difference in the magnitude of ONSD change was observed between the PF and NPF groups ( > 0.05). Group P showed lower ejection fractions and higher total inotrope requirements compared to Group NP ( < 0.01), but these factors did not translate into differences in postoperative ICP dynamics. ONSD measurements increased significantly after CABG surgery, regardless of perfusion type. PF and NPF strategies were comparable in terms of their effects on ICP as reflected by ONSD changes. ONSD ultrasonography appears to be a simple, rapid, and non-invasive tool for perioperative ICP monitoring in cardiac surgery. Further studies are needed to confirm these findings with dynamic intraoperative monitoring and neurocognitive assessments.
在冠状动脉旁路移植术（CABG）手术中，由于存在神经学风险，监测颅内压（ICP）至关重要。尽管体外循环（CPB）期间的搏动血流（PF）被认为比非搏动血流（NPF）更符合生理状态，但其对ICP的影响仍不明确。本研究旨在比较PF和NPF技术术前和术后的视神经鞘直径（ONSD）测量值，以评估它们对ICP变化的影响。60例行择期CABG的患者（年龄45 - 75岁，美国麻醉医师协会分级II - III - IV级）被纳入研究，并根据外科医生确定的体外循环技术分为两组：PF组（P组，n = 30）和NPF组（NP组，n = 30）。术前（Tpreop）和术后（Tpostop）用超声测量ONSD。同时记录血流动力学参数以及颈静脉和颈动脉直径。统计分析包括t检验、曼 - 惠特尼U检验、卡方检验和皮尔逊相关性分析。与术前值相比，两组术后ONSD均显著增加（P < 0.001）。然而，PF组和NPF组之间ONSD变化幅度无统计学显著差异（P > 0.05）。与NP组相比，P组的射血分数较低且总的血管活性药物需求量较高（P < 0.01），但这些因素并未转化为术后ICP动态变化的差异。无论灌注类型如何，CABG术后ONSD测量值均显著增加。从ONSD变化反映的对ICP的影响方面来看，PF和NPF策略具有可比性。ONSD超声检查似乎是心脏手术围手术期ICP监测一种简单、快速且无创的工具。需要进一步的研究通过术中动态监测和神经认知评估来证实这些发现。
