机器人腹腔镜下前列腺癌根治术中过度通气策略对颈静脉球压力和视神经鞘直径的影响

发布时间：2018-05-12 19:05

本文选题：机器人辅助手术 + 前列腺癌根治术　；参考：《实用医学杂志》2017年06期

【摘要】：目的:观察机器人辅助下前列腺癌根治术(RALRP)中过度通气策略对患者颈静脉球压力(JBP)和视神经鞘直径(ONSD)的影响。方法:择期行RALRP患者20例,全身麻醉后过度通气,记录插管后5 min(T_0)、Trendelenburg体位后15 min(T_1)、建立气腹30、60、90 min(T_2、T_3、T_4)和停气腹平卧后15 min(T_5)呼吸末二氧化碳(ETCO_2)、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、气道峰压(PIP)、JBP和ONSD的变化。结果:与T_0比较,T1~T5时间点JBP升高(P0.05)。过度通气期间T_1~T_5的ETCO_2和PaCO_2较T_0降低(P0.05)。Trendelenburg体位和气腹建立后,PIP值T_1~T_4较T_0升高(P0.05),但ONSD在T_3~T_5各较T_1~T_2升高(P0.05)。结论:RALRP中采用过度通气,建立气腹及Trendelenburg体位后患者JBP和PIP增高,ONSD逐渐增宽。
[Abstract]:Objective: to observe the effect of hyperventilation strategy on jugular bulbar pressure (JBP) and optic nerve sheath diameter (ONSD) in robotic assisted radical prostatectomy for prostate cancer (RALRP). Methods: twenty patients with RALRP were treated with hyperventilation after general anesthesia. Five minutes after intubation, 15 mins after the posture of Trendelenburg, 15 mins after the establishment of the pneumoperitoneum, 306090 mins of the pneumoperitoneum were established. The level of T _ 2T _ 3T _ 4) and 15 min after the cessation of pneumoperitoneum were recorded.) the changes of end-respiratory carbon dioxide (ETCO _ 2), arterial partial pressure of oxygen (Pao _ 2), partial pressure of arterial carbon dioxide (Paco _ 2T _ 2), peak airway pressure (PIP) and ONSD were recorded. Results: compared with T _ 0, JBP of T _ 1 T _ 5 increased P 0.05. During hyperventilation, the ETCO_2 and PaCO_2 of T_1~T_5 were lower than that of T _ (0). The values of ETCO_2 and PaCO_2 in T_1~T_5 were significantly higher than those in T _ (0) after postural and pneumoperitoneum establishment, but ONSD in T_3~T_5 was higher than that in T_1~T_2, respectively. Conclusion the JBP and PIP of the patients with hyperventilation were increased after establishing pneumoperitoneum and Trendelenburg position.
【作者单位】：四川省医学科学院·四川省人民医院麻醉科;
【基金】：四川省卫生和计划生育委员会科研课题(编号:16PJ459)
【分类号】：R737.25;R614

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