背景:在妇科腹腔镜手术期间,气腹和Trendelenburg位置(TP)可导致颅内压升高(ICP)。然而,目前尚不清楚围手术期液体治疗是否影响ICP.这项研究的目的是通过测量视神经鞘直径(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例进行腹腔镜妇科手术的患者随机分为CF组和RF组。主要结果是两组之间在预定时间点的ONSD/ETD比率的差异。次要结果是术中循环参数(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,麻醉后护理室的停留时间,术后并发症,和住院时间)。
结果:两组之间的ONSD/ETD比率和ONSD随时间的变化没有统计学上的显着差异(均p>0.05)。从T2到T4,两组的ONSD/ETD比率和ONSD均高于T1(均p<0.001)。从T1到T2,两组的ONSD/ETD比率均增加了14.3%。然而,RF组的拔管时间短于CF组[中位数差异(95%CI)-11(-21至-2)min,p=0.027]。其他次要结果没有差异。
结论:在接受腹腔镜妇科手术的患者中,射频没有显著降低ONSD/ETD比值,但缩短了气管拔管时间,与CF相比。
背景:ChiCTR2300079284。2023年12月29日注册。
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.
CONCLUSIONS: 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.
BACKGROUND: ChiCTR2300079284. Registered on December 29, 2023.