摘要
目的:探讨瑞芬太尼对妇科腹腔镜气腹期间眼内压的影响。方法:择期全身麻醉下行妇科腹腔镜手术的患者90例,采用随机数字表法分为5组(n=18):低剂量芬太尼组(F1组)、高剂量芬太尼组(F2组)、低剂量瑞芬太尼组(R1组)、中剂量瑞芬太尼组(R2组)、高剂量瑞芬太尼组(R3组)。腹腔镜手术人工气腹前即刻F1和F2组分别静脉注射芬太尼2、4μg/kg,R1组、R2组和R3组静脉注射负荷剂量1μg/kg瑞芬太尼后微泵以0.1、0.2和0.4μg·kg-1·min-1速度持续输注。记录气腹前即刻(T0)、气腹和头低脚高位后10(T1)、30(T2)、60(T3)、90 min(T4)、结束气腹和恢复平卧位后10 min(T5)时的眼内压(IOP)、平均动脉压(MAP)、心率(HR);记录各组术毕拔管时间。结果:与T0比较,F1、F2和R1组T1~T5时IOP显著增高(P<0.01),F1组T1~T4、R1组T1~T5时MAP明显升高(P<0.01),F2、R3组T1~T5时HR明显降低(P<0.01);与R2、R3组比较,F1、F2和R1组T1~T4时IOP,F1、R1组T1~T5时MAP、HR均明显增高(P<0.05)。术中高眼内压发生率F1、F2和R1组高于R2、R3组(P<0.05);高血压、窦性心动过速发生率F1、R1组高于F2、R2和R3组(P<0.05)。R3组窦性心动过缓发生率、F2组术毕拔管时间均明显高于其他四组(P<0.05)。结论:静脉输注瑞芬太尼0.2μg·kg-1·min-1能够降低妇科腹腔镜气腹期间升高的IOP,且血流动力学平稳,麻醉苏醒迅速,适合于妇科腹腔镜手术的麻醉维持。
AIM： To observe the effects of remifentanil on intraocular pressure （IOP） undergo- ing laparoscopic gynecological surgery. METH- ODS： Ninety patients of ASA physical status I or II , were randomly allocated to 5 groups （n = 18 each） ： low dose fentanyl group （ group F1 ）, high dose fentanyl group （group F2）, low dose remifen- tanil group （group R1 ）, medium dose remifentanil group （group R2） and high dose remifentanil group （ group R3 ） . Upon pneumoperitoneum, Group F1, F2 received fentanil 2 or 4 mcg/kg intravenous bolus while Group R1, R2, R3 received intravenous load- ing dose of 1 mcg/kg followed by continuous infusions of remifentanil of 0.1, 0.2, or 0.4 μg·kg^-1·min^-1 till the end of the surgery, IOP, MAP, HR were recorded before （T0）, 10 min （T1）, 30 min （T2 ）, 60 min （ T3 ） and 90 min （ W4 ） after onset of pneumoperitoneum and at 10 min（T5 ） after the end of pneumoperitoneum. Time to extubation after dis- continue of anesthesia, incidence of intraocular hy- pertension （ lOP 〉 21 mm Hg） , hypertension （ SBP 〉 140 mm Hg）, hypotension（ SBP 〈 90 mm Hg）, sinus tachycardia（ HR 〉 100 beat/min） , sinus brad- ycardia （HR 〈 60 beat/min） were recorded. RE-SULTS：Compared with To, IOP at Tt-T5 in group F1, F2, R1, MAP at T1-T4 in group F1 and T1-T5 in group R1 were significantly increased while HR at T1-T5 in group F2,R3 were significantly lower （P〈 0.01）. Compared with group R2 and R3, IOP at T1-T4 in group F1, F2, R1, MAP and HR at T1-T5 in group F1, R1 were significantly increased （P〈 0.01 ）. The incidence of intraocular hypertension of group FI , F2 and R1 was significantly higher than that of group R2 and R3 （ P 〈 0. 005 ）. The incidence of hypertension and sinus tachycardia of group F1 and R1 were significantly higher than that of group F2, R2 and R3 （ P〈 0. 005 ）. The incidence of sinus bradycardia of group R3 and extubation time of group F2 was significantly higher than that in the other 4 gr
作者
余亮
周大春
刘洋
高斌
YU Liang;ZHOU Dachun;LIU Yang;GAO Bin(Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016 ,Zhejiang , China;Department of Anesthesiology ,Huzhou Central Hospital , Huzhou 313000 ,Zhejiang , China)
出处
《中国临床药理学与治疗学》
CAS
CSCD
2017年第9期1062-1066,共5页
Chinese Journal of Clinical Pharmacology and Therapeutics
关键词
腹腔镜手术
瑞芬太尼
眼内压
并发症
laparoscopic surgery
remifentanil
intraocular pressure
complication
