31名接受全内镜脊柱手术的患者的非侵入性内压力概况
André Tosta Ribeiro1, Marcelo Campos Moraes Amato1, Ricardo Santos de Oliveira1
1Universidade de São Paulo - Faculdade de Medicina de Ribeirão Preto - Departmento de Cirurgia e Anatomia - Ribeirão Preto (SP) - Brazil.
Acta cirurgica brasileira
|September 25, 2024
概括
尽管用盐水灌,全内镜脊柱手术可能不会增加内压力 (ICP). 麻醉似乎可以在手术期间防止ICP变化,这是非侵入性ICP监测表明的.
科学领域:
- 神经外科 神经外科
- 麻醉学 麻醉学
- 医疗器械 医疗器械
背景情况:
- 全内镜脊柱手术 (FESS) 涉及持续的盐水灌,引发了人们对内压力 (ICP) 可能增加的担忧.
- 非侵入性ICP监测提供了一种方法来评估这些潜在的变化,而不需要侵入性程序.
研究的目的:
- 为了评估FESS期间盐水灌对非侵入性测量的ICP波形的影响.
- 为了将ICP参数的变化与手术期间的流体动力学和生命体征相关联.
主要方法:
- 在接受FESS的患者中使用额外状应变传感器进行非侵入性ICP (n-ICP) 监测.
- 在多个手术时间点分析了ICP波形参数 (P2/P1比率,达到峰值的时间).
- 相关的n-ICP参数与手术内流体参数和生命体征使用统计分析.
主要成果:
- 在FESS期间观察到P2/P1比率和峰值时间的显著下降 (p < 0.001和p < 0.004).
- 与基线相比,n-ICP参数和生命体征在术后仍然明显较低.
- 在整个手术过程中,液体参数和ICP参数之间没有发现显著的相关性.
结论:
- 麻醉诱导导致n-ICP参数的下降,与盐水灌的预期上升相反.
- n-ICP参数显示独立于流体参数,这表明麻醉可能对FESS期间的ICP升高具有保护作用.
相关概念视频
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...