不同靶浓度瑞芬太尼复合异丙酚对病人麻醉诱导时眼内压的影响

Effect of different plasma concentrations of remifentanil on intraocular pressure

目的评价不同靶浓度瑞芬太尼对麻醉诱导时病人眼内压(IOP)的影响。方法60例ASAⅠ级择期行鼻内窥镜手术病人,随机分为4组:R0组、R2组、R4组、R6组,每组15例。监测平均动脉压(MAP)、心率(HR)、脑电双频谱指数(BIS)、IOP。靶控输注异丙酚,血浆靶浓度为3μg/ml,5min后R2组、R4组、R6组分别靶控输注血浆靶浓度为2、4、6 ng/ml瑞芬太尼,R0组静脉注射3μg/kg芬太尼,3min后气管插管。BIS低于70时静脉注射0.1 mg/kg维库溴铵。记录入室后(基础值)、靶控输注瑞芬太尼前(T1)、气管插管前(T2)及气管插管后5min内最大值(T3)的IOP、MAP和HR。将靶控输注瑞芬太尼前后MAP与IOP的变化差值进行直线相关分析。结果与基础值相比,输注瑞芬太尼后R2组、R4组及R6组IOP下降(P<0.05),组间比较差异无统计学意义(P>0.05);气管插管后R2组IOP明显升高(P<0.05),但仍低于基础值。R2组、R4组、R6组MAP与IOP的变化差值的相关系数分别0.803、0.835及0.883(P<0.05),IOP下降与MAP下降程度呈正相关。结论靶控输注瑞芬太尼可明显降低麻醉诱导时病人的IOP,靶浓度4、6 ng/ml可抑制气管插管引起眼内压的上升。

Objective To evaluate the effect of different target plasma concentrations of remifentanil on intraocular pressure during induction of general anesthesia.Methods Sixty ASA Ⅰ patients undergoing general anesthesia were randomly divided into 4 groups （ n = 15 each） ： group I control group received a bolus of fentanyl 3 μg·kg^-1 ; group Ⅱ , Ⅲ, Ⅵ received TCI of remifentanil at target plasma concentrations of 2, 4 and 6 ng·ml ^-1 . The patients were unpremedlcated. MAP, HR and BIS were monitored before and during anesthesia. Anesthesia was induced with TCI of propofol at target plasma concentration of 3 μg·ml^- 1 . TCI of remifentanil was started 5 rain later. When BIS was below 70, vecuronium 0.1 mg·kg^-1 was administered i.v. and the patients were intubated. Intraocular pressure （IOP）, MAP and HR were measured and recorded before induction of anesthesia （baseline, TO ）, before start of remifentanil by TCI （T1 ）, before intubation （ T2 ）, every minute after tracheal intubation for 5 min （T3-8 ）. All the data were analyzed with SPSS 11.0 statistical software.Results IOP was significantly decreased after remifentanil in group Ⅱ , Ⅲ , Ⅵ as compared with control group （ Ⅰ ）, but was not significantly different among the 3 groups. The decrease in IOP was closely related to decrease in MAP. IOP was significantly increased after tracheal intubation in group Ⅱ but did not exceed the baseline value at TO . Conclusion Remifentanil can decrease IOP. Remifentanil given by TCI at target plasma concentration of 4 and 6 μg·ml^-1 can inhibit increase in IOP induced by intubation.