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| 经皮肾镜取石术中不同通气策略对视神经鞘直径的影响 |
| Effect of different mechanical ventilation on optic sheath diameter in patients undergoing percutaneous nephrolithotomy |
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| DOI：10.12089/jca.2019.12.001 |
| 中文关键词: 俯卧位 颅内压 机械通气 视神经鞘直径 经皮肾镜取石术 |
| 英文关键词: Prone position Intracranial pressure Mechanical ventilation Optic nerve sheath diameter Percutaneous nephrolithotomy |
| 基金项目:国家自然科学基金(81771142,81870875);江苏省医学重点学科(ZDXKA2016018);江苏省青年医学人才(QNRC2016014);江苏省“六大人才高峰”(YY-077,YY-084) |
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| 中文摘要: |
目的 观察在经皮肾镜取石术(percutaneous nephrolithotomy, PCNL)中采用肺保护性通气模式对视神经鞘直径(optic nerve sheath diameter, ONSD)的影响。
方法 全身麻醉下行择期PCNL患者30例,男19例,女11例,年龄≥18岁,ASA Ⅰ-Ⅲ级,采用随机数字表法将患者随机分为两组,每组15例。常规机械通气组(C组)设置VT 8 ml/kg,PEEP 0 cmH2O;肺保护性通气组（P组）设置VT 6 ml/kg,PEEP 5 cmH2O。分别在麻醉诱导前5 min(T0)、改俯卧位前5 min(T1)、俯卧位后10 min(T2)、1 h(T3)、改平卧位后10 min(T4)应用床旁超声实时测量左右眼球后3 mm处ONSD。分别在T1-T4时采集动脉血进行血气分析,计算氧合指数(OI)。术后随访患者恶心呕吐、头晕、头痛以及肺部并发症的发生情况。
结果 与T1时比较,T2-T4时两组双侧ONSD明显增加(P<0.05)。与T3时比较，T4时两组双侧ONSD明显减小（P<0.05）。与C组比较,T3、T4时P组OI明显升高(P<0.05)。两组术后恶心呕吐、头晕、头痛以及肺部并发症发生率差异无统计学意义。
结论 经皮肾镜取石术中,俯卧位可显著增加患者的ONSD,但平卧位或俯卧位下行小潮气量联合低水平PEEP通气策略对ONSD无明显影响。 |
| 英文摘要: |
Ojective To evaluate the effect of different mechanical ventilation strategies on optic nerve sheath diameter (ONSD) in patients undergoing percutaneous nephrolithotomy (PCNL).
Methods Thirty patients undergoing elective PCNL under general anesthesia,19 males and 11 females, aged ≥18 years, ASA physical status Ⅰ-Ⅲ, were randomly divided into two groups (n = 15 in each group): group C received conventional mechanical ventilation, tidal volume (VT) 8 ml/kg, positive end-expiratory pressure (PEEP) 0 cmH2O; group P received lung protective ventilation, VT 6 ml/kg, PEEP 5 cmH2O. The ONSD at 3 mm behind the eyeball was measured by bedside ultrasound at 5 min before anesthesia induction (T0), 5 min before prone position (T1), 10 min after prone position (T2), 1 h after prone position (T3), and 10 min after supine position (T4). The arterial blood was collected at T1, T3 and T4 for blood gas analysis, and the oxygenation index (OI) was calculated. The incidence of postoperative nausea, vomiting, dizziness, headache and pulmonary complications was followed up.
Results Compared with T1, the ONSD in both groups increased significantly at T2-T4(P < 0.05). Compared with group C, OI in group P increased significantly at T3 and T4(P < 0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, dizziness, headache and pulmonary complications between the two groups.
Conclusion Prone position can significantly increase ONSD in patients undergoing PCNL, but low tidal volume combined with low level PEEP ventilation strategy in prone or supine position has no significant effect on ONSD. |
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