Objective:To observe the change of intracranial pressure (ICP ) and cerebral hemodynamics of elderly patients undergoing laparoscopic gynecological surgery in modified chest‐up Trendelenburg position (T position ) by ultrasound . Methods :Forty ASA I‐Ⅱ patients ,aged ≥ 60 yr ,weighed 44‐69 kg ,scheduled for elective gynecological surgery ,were randomly divided into 2 groups with 20 in each .Patients of study group(group M ) were placed in chest‐up T position by using custom made posture cushions .And patients of control group(group T ) were placed in conventional T position .The optic nerve sheathdiameter(ONSD),time‐averagepeakvelocity(TAPV)ofmiddlecerebralartery,pulseindex(PI),andresistanceindex (RI) in supine position at 5 min after regular general anesthesia induction (T1 ) ,and that in modified T position or T position immediately after pneumoperitoneum (T2 ) ,30 min later(T3 ) ,60 min later(T4 ) ,90 min later(T5 ) ,and that in horizon position at 15 min after deflation(T6 ) ,were measured .Results:Compared with that at T1 ,the TAP and PI at T2 ,3 ,4 ,5 significantly increased in both groups ,the ONSD and RI at T4 ,5 significantly increased in group M ,and the ONSD and RI at T3 ,4 ,5 ,6 and PI at T6 significantly increased in group T (P<0 .05) .Compared with that in group T ,the ONSD and RI at T3 and T6 significantly decreased in group M ,and the TAP and PI at T2 significantly decreased in group M (P<0 .05) .Conclusions :Modified chest‐up T position delays the increase of ICP and cerebral blood flow (CBF) ,and accelerates their recovery to the normal range after deflation .It is conducive to the safety of prolonged surgery .%目的：应用超声观察改良抬胸Trendelenburg体位（简称T位）时妇科腹腔镜手术老年患者的颅内压（ICP）和脑血流动力学的变化。方法：择期行妇科腹腔镜手术的患者40例，年龄60岁以上，体质量44～69 kg ，美国麻醉医师协会（ASA ）分级Ⅰ～Ⅱ级，随机分为2组，每组20例。研究组（M组）加用定制体位垫，使患者呈改良抬胸T位，对照组（T组）采用T位手术。于常规全麻插管后平卧位5 min（T1），气腹改良抬胸T位／T位即刻（T2）、30 min（T3）、60 min（T4）和90 min（T5），气腹放气平卧位15 min（T6）分别测量视神经鞘直径（ONSD）、大脑中动脉（MCA）时间平均峰值流速（TAP）、搏动指数（PI）和阻力指数（RI）。结果：与T1时比较，两组T2，3，4，5时TAP和PI升高，M组T4，5时ONSD和RI升高；T组T3，4，5，6时ONSD、RI升高，T6时PI升高，P＜0．05。与T组比较，M组T3和T6时ONSD和RI减小，T2时TAP和PI降低，（P＜0．05）。结论：改良抬胸T位延缓了颅内压和脑血流量（CBF）升高的发生，且气腹结束后颅内压较早恢复正常，有利于较长时间手术的安全。
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