瑞芬太尼对妇科腹腔镜气腹期间眼内压的影响

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (9): 1062-1066.

瑞芬太尼对妇科腹腔镜气腹期间眼内压的影响

余亮^1,2，周大春¹，刘洋²，高斌²

¹浙江大学医学院附属邵逸夫医院麻醉科，杭州 310016，浙江；²湖州市中心医院麻醉科，湖州 313000，浙江

收稿日期:2017-05-03 修回日期:2017-09-06 出版日期:2017-09-26 发布日期:2017-09-30
通讯作者: 周大春，男，硕士，主任医师，硕士研究生导师，研究方向：麻醉与器官保护、麻醉与肿瘤免疫、麻醉设备与麻醉安全等方面。 Tel:13588708510 E-mail: 3192028@zju.edu.cn
作者简介:余亮，男，在职研究生,主治医师，研究方向：临床麻醉与全麻药品药理、毒理。 Tel:13868298615 E-mail:cangxingyulian@163.com

Effects of remifentanil on intraocular pressure during laparoscopic surgery in the steep trendelenburg position

YU Liang^1,2, ZHOU Dachun ¹, LIU Yang², GAO Bin²

¹ Department of Anesthesiology, Sir Run Run Shaw Hospital,School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang, China; ²Department of Anesthesiology, Huzhou Central Hospital, Huzhou 313000, Zhejiang, China

Received:2017-05-03 Revised:2017-09-06 Online:2017-09-26 Published:2017-09-30

摘要/Abstract

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、4 μg/kg，R1组、R2组和R3组静脉注射负荷剂量1 μg/kg瑞芬太尼后微泵以0.1、0.2和0.4 μg·kg-1·min-1速度持续输注。记录气腹前即刻（T0）、气腹和头低脚高位后10（T1）、30（T2）、60（T3）、90 min（T4）、结束气腹和恢复平卧位后10 min（T5）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T0比较，F1、F2和R1组T1～T5时IOP显著增高（P<0.01），F1组T1～T4、R1组T1～T5时MAP明显升高（P<0.01），F2、R3组T1～T5时HR明显降低（P<0.01）;与R2、R3组比较，F1、F2和R1组T1～T4时IOP ，F1、R1组T1～T5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0.2 μg·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。

关键词: 腹腔镜手术, 瑞芬太尼, 眼内压, 并发症

Abstract:

AIM: To observe the effects of remifentanil on intraocular pressure (IOP)undergoing laparoscopic gynecological surgery. METHODS: Ninety patients of ASA physical status ⅠorⅡ, were randomly allocated to 5 groups (n=18 each): low dose fentanyl group (group F1), high dose fentanyl group (group F2), low dose remifentanil 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 loading 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(T4) after onset of pneumoperitoneum and at 10 min(T5) after the end of pneumoperitoneum. Time to extubation after discontinue of anesthesia, incidence of intraocular hypertension (IOP>21 mm Hg), hypertension (SBP>140 mm Hg), hypotension(SBP<90 mm Hg), sinus tachycardia(HR>100 beat/min), sinus bradycardia (HR<60 beat/min) were recorded.RESULTS:Compared with T0 , IOP at T1-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 F1 , 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 groups（P''<0.005,P<0.05）.CONCLUSION:Infusion of 0.2 μg·kg-1·min-1 of remifentanil can alleviate intraocular pressure elevation in patients undergoing gynecological laparoscopic surgery without worsen hemodynamic stability or delay the emergence of anesthesia.

Key words: laparoscopic surgery, remifentanil, intraocular pressure, complication

中图分类号:

R713

余亮，周大春，刘洋，高斌. 瑞芬太尼对妇科腹腔镜气腹期间眼内压的影响[J]. 中国临床药理学与治疗学, 2017, 22(9): 1062-1066.

YU Liang, ZHOU Dachun, LIU Yang, GAO Bin. Effects of remifentanil on intraocular pressure during laparoscopic surgery in the steep trendelenburg position [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(9): 1062-1066.

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