右美托咪定联合瑞芬太尼对行气管内插管时眼内压的影响

Effect of Dexmedetomidine Combined with Remifentanil for Tracheal Intubation on Intraocular Pressure

目的观察不同麻醉药物的组合对IOP的影响,探讨最佳组合方式。方法择期行鼻内镜手术患者60例,ASA分级I~Ⅱ级,随机分为4组：Y1组（右美托咪定0.4μg/kg＋瑞芬太尼4ng/ml,n=15例）,Y2组（右美托咪定0.4μg/kg＋瑞芬太尼6ng/ml,n=15例）,Y3组（右美托咪定0.6μg/kg＋瑞芬太尼4ng/ml,n=14例）,Y4组（右美托咪定0.6μg/kg＋瑞芬太尼6ng/ml,n=14例）。术前不使用任何术前麻醉用药,采用Schiotz眼压计测定IOP,麻醉诱导前Y1、Y2组给予右美托咪定0.4μg/kg,Y3、Y4组给予右美托咪定0.6μg/kg。静脉注射依托咪酯0.3mg/kg待睫毛反射消失,Y1、Y3组靶控输注血浆靶浓度为4 ng/ml瑞芬太尼,Y2、Y4组靶控输注血浆靶浓度为6ng/ml瑞芬太尼,NI大于50时静脉给予罗库溴铵0.6 mg/kg,辅助通气维持PET CO2在35~45mm Hg之间,经口明示气管插管。观察并记录给予右美托咪定前（T0）、给予右美托咪定后3min（T1）、给予瑞芬太尼前即刻（T2）、插管即刻（T3）、插管后5min（T4）的MAP、HR、IOP。结果 MAP、HR、IOP在T0、T1、T2三个时间点组内和组间比较差异无统计学意义,P〉0.05。与T0比较,在T3时间点四组患者在MAP、IOP与T0比较均有显著性差异,P〈0.05,组间比较差异无统计学意义,P〉0.05。在T3时间点,Y3组与Y4组在HR上与T0比较差异有显著性,P〈0.05。结论 0.4μg/kg的右美托咪定复合靶控输注血浆靶浓度4ng/ml瑞芬太尼就能够降低气管插管前IOP,并能够抑制由于插管引起的高眼压反应。该结果对于术前合并有高眼压的青光眼患者,以及眼外伤和近期实施过内眼手术的患者有临床指导意义。

Objective To investigate the influence of different combination of anesthetic drugs on IOP,and to select the best combination.Methods Sixty elective endoscopic sinus surgery cases,ASA grade I ~Ⅱ,were randomly divided into 4 groups：Y1 group（dexmedetomidine given 0.4μg / kg ＋ remifentanil 4ng/ml,n=15）,Y2 group（dexmedetomidine given 0.4μg / kg ＋ remifentanil 6ng/ml,n=15）,Y3 group（dexmedetomidine given 0.6μg / kg ＋ remifentanil 4ng/ml,n=14）,Y4 group（dexmedetomidine given 0.6μg / kg ＋remifentanil 6 ng/ml,n=14）.Without any preoperative anesthetic,Schiotz tonometer was used for measuring IOP.Before induction of anesthesia,dexmedetomidine was given at 0.4μg / kg to Y1 and Y2 group,meanwhile at 0.6μg / kg to Y3 and Y4 group.Intravenous inject etomidate at 0.3 mg / kg and waiting for eyelash reflex disappeared,then Y1,Y3 group received remifentanil at 4ng/ml,Y2,Y4 group received remifentanil at 6ng/ml,administered rocuronium intravenously at 0.6 mg / kg when NI was greater than 50 rocuronium,ventilation was assisted to maintain PET CO_2 between 35 ~ 45 mm Hg.MAP,HR and IOP were recorded at T0（before given dexmedetomidine）,T1（3min after given dexmedetomidine）,T2（immediately after given remifentanil）,T3（immediately after intubation） and T4（5min after intubation）.Results There was no significant difference at MAP,HR,IOP in T0,T1,T2（P〈0.05）.Compared with T0,MAP and IOP of four groups at T3 have significant differences（P〈0.05）,the difference between intra-groups were not statistically significant（P〈0.05）.At time point T3,HR of Y3 and Y4 group had significant differences when compared with T0（P〈0.05）.Conclusion Combinde dexmedetomidine at 0.4μg/kg with remifentanil at 4ng/ml before endotracheal intubation can reduce IOP,and suppressed ocular hypertension from endotracheal intubation.It can guide anesthesia treatment for glaucoma patients and intraocular surgery patient whose IOP was higher.