Changes In Optic Nerve Sheath Diameter In Patients Undergoing Gynecological Laparoscopic Operation In Trendelenburg Position

Objective:To ensure the intraoperative safety of patients’.Estimating the changes of intracranial pressure by ultrasonographically measuring optic nerve sheath diameter（ONSD）in patients undergoing gynecological laparoscopic operation with Trendelenburg position.Methods:This is a self-control study.Subjects of this study were patients undergoing selective gynecological laparoscopic operation with Trendelenburg position in Shaanxi Provincial People’s Hospital between January 1,2018 and May 31,2018.Patients’ONSD was measured using ocular ultrasonography 3min after tracheal intubation in supine position（T0）,3 min after the combination of CO₂ pneumoperitoneum and Trendelenburg position（T1）,30 min after the combination of CO₂ pneumoperitoneum and Trendelenburg position（T2）,60 min after the combination of CO₂ pneumoperitoneum and Trendelenburg position（T3）,3min after cease CO₂ pneumoperitoneum and convert back into supine position.Patients vital signs was also recorded at each measuring point.Data were analyzed with the software SPSS 22.0,measurement data were expressed as means±SD.Repeated measurement data were analyzed by repeated measures analysis of variance,pairwise comparison at each point was conduct by Bonferroni post hoc test.Pearson correlation coefficient was used for the correlation analysis of normal distribution data,while Spearman’s rank correlation coefficient was used for abnormal distribution data.P<0.05 was considered statistically significant in difference.Results:60 patients undergoing gynecological laparoscopic operation with Trendelenburg position were included.Average ONSD values（mm）were T0=5.34±0.27,T1=5.78±0.23,T2=5.63±0.28,T3=5.56±0.30,T4=5.41±0.30,ONSD has a significant difference between each measuring point（P<0.05）.Patients’BMI and MAP was considered to have a positive correlation with the increase of ONSD after the combination of CO₂ pneumoperitoneum and Trendelenburg position（r=0.312,P=0.015;r=0.366,P=0.004）.Conclusions:The combination of CO₂ pneumoperitoneum and Trendelenburg position can lead to a significant increase in patients’ONSD during gynecological laparoscopic operation with Trendelenburg position.BMI and MAP was considered to have a positive correlation with the increase of patients’ONSD.It indicated a significant increase of patients’intracranial pressure while undergoing a gynecological laparoscopic operation with Trendelenburg position,and the increasing range may have a positive correlation with patients’BMI and MAP.