| BackgroundWith the rapid development of laparoscopic technology,laparoscopic surgeries are more mature,and being widely used.Gynecological laparoscopic surgeries have ranged from multiple ports to single port,from traditional laparoscopic surgery to robot-assisted laparoscopic surgery,from laparoscopic radical surgery for endometrial cancer and cervical cancer to the laparoscopic staging of ovarian cancer,which have improved the level of clinical diagnosis and therapy,provided surgical patients with better conditions for postoperative quality rehabilitation as well.However,gynecological laparoscopic radical resection always takes a long time to be accomplished,and patients are put in trendelengurg position,filled with carbon dioxide in enterrocoelia,which causes certain pathophysiological changes in these patients and the difficulties of intraoperative management during the perioperative period are increased.Long-term carbon dioxide pneumoperitoneum and trendelenburg position can cause intracranial venous blood backflow obstruction,cerebral edema,increased brain intracranial pressure.Increased intracranial pressure can cause a series of neuropsychiatric symptoms and even cerebral hernia in some severe cases.Therefore,the increase in intracranial pressure caused by non-cranial diseases should be paid more attention and actively prevented.The optic nerve is the second pair of cranial nerves.In the posterior aspect of the iliac crest,the transcranial canal enters the cranial fossa.The structure surrounded by the optic nerve surface is the optic nerve sheath.It is composed of three layers of meningeal structure,covered Subarachnoid space from the brain.The aqueous humor,lens and vitreous in the eyelids have good sound transmission,and the ultrasound the shape of the posterior optic nerve and the optic nerve sheath can be clearly observed.The optic nerve sheath is adjacent to the intraocular structure and the intracranial structure,so it can reflect the intraocular and intracranial lesions to some extent.Hypertonic gel solution is a mixture of hypertonic saline and hydroxyethyl starch.In this study,we used hypertonic sodium chloride hydroxyethyl starch 40 injection(HSH40),which is a containing 4.2% sodium chloride and 7.6% hydroxyethyl starch.The molecular weight HSH40 is 40 kd,its osmotic pressure is 1440mOsm/L,and its degree of substitution is 0.8-1.3.It takes the role of hypertonic dehydration as well as blood volume maintenance.ObjectiveThis study sought to find a way to reduce intracranial pressure in patients undergoing radical gynecologic malignant tumor surgery and to strengthen perioperative brain protection.Therefore,this study intends to explore the effect of HSH40 on the intraoperative intracranial pressure in patients undergoing gynecological laparoscopic malignant radical surgery via the optic nerve sheath diameter measured by ultrasound.MethodsPatients who underwent gynecological laparoscopic malignant radical surgery at the Second Affiliated Hospital of Zhengzhou University from January 1,2018,to June 30,2018 were selected as subjects.A total of 40 eligible subjects were included.They were divided into two groups(n=20)by random number table method,which were group HSH40(group H)and group saline(group N).After entering the operating room,the patient was connected to the monitor and was opened venous access,then radial artery puncture and catheterization was performed under local anesthesia and continuous arterial pressure was monitored.When everything was ready,routine anesthesia induction was performed.Video laryngoscopy assisted tracheal intubation was performed and then to confirm the position of the endotracheal tube.Intraoperative intravenous anesthesia is maintained during the surgery.In group H,HSH40 was infused at 5ml/kg at 150 min after pneumoperitoneum within 30 min,and the same dose of saline was infused at the same time.The optic nerve sheath diameter of both eyes,mean artery pressure,heart rates,peak inspiratory airway pressure,partial pressure of carbon dioxide in arterial blood,at 5 min after regular general anesthesia induction in supine position(T0),10min(T1),60min(T2),120min(T3),180min(T4)after trendelenburg position and pneumoperitoneum,and 10 min after that in supine position(T5),were measured.SPSS23.0 software was used for statistical data analysis.Result1.Comparison of ONSD:Individual effect analysis within the group: The level of ONSD at T4 was significantly higher than that at T0-T3 in group N(P<0.05),while the ONSD of the patients in group H at T4 was significantly lower than that at T3(P<0.05).Individual effect analysis between groups: there was no significant difference in ONSD at T0-T3 between the two groups(P>0.05),but the levels of ONSD in group H were significantly lower than those in group N at T4 and T5(P<0.05).2.Comparison of MAP:Individual effect analysis within the group: there were no significant difference of the MAP between T3 and T4 in both two groups(P<0.05).Individual effect analysis between groups: the differences between the levels of MAP at T0-T3 had no statistical significance between the two groups(P>0.05),but the levels of MAP in group H were significantly higher than those in group N at T4 and T5(P<0.05).3.Comparison of PaCO2:Individual effect analysis within the group: The levels of PaCO2 in both of group H and N at T1-T4 were significantly higher than those at T0(P<0.05).Individual effect analysis between groups: the difference between the levels of PaCO2 at T0-T5 had no statistical significance between the two groups(P>0.05).4.Comparison of HR:Individual effect analysis within the group:compared with T0,the differences between the levels of HR at T1-T4 had no statistical significance,in both of group H and N(P>0.05).Individual effect analysis between groups: the difference between the levels of HR at T0-T5 had no statistical significance between the two groups(P>0.05).5.Comparison of PIP:Individual effect analysis within the group: the levels of PIP in both of group H and N at T1-T4 were significantly higher than those at T0(P<0.05).Individual effect analysis between groups: the difference between the levels of PIP at T0-T5 had no statistical significance between the two groups(P>0.05).ConclusionThe the optic nerve sheath diameter of gynecology malignancy patients can be increased significantly during laparoscopic surgery for gynecologic malignant tumors.HSH40 reduces the optic nerve sheath of these patients,which can reduce the intracranial pressure. |
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