雷米芬太尼对妇科腹腔镜术中眼内压的影响

Effect of remifentanil on intraocular pressure during laparoscopic gynecologic operations

目的观察雷米芬太尼对妇科腹腔镜术中眼内压变化的影响。方法40例全凭静脉麻醉下行妇科腹腔镜手术的患者随机均分为两组，对照组（Ⅰ组）和雷米芬太尼组（Ⅱ组）。所有患者均采用静脉注射咪达唑仑、异丙酚、维库溴铵、芬太尼麻醉诱导，持续输注异丙酚、间断静脉注射维库溴铵麻醉维持。Ⅱ组加用雷米芬太尼。使用笔式眼压计（Tono Pen XL Tonometer）分别于全麻后5min（T0）、气腹后5min（T1）、气腹后15min（T2）、气腹结束前5rain（T3）、气腹结束后5min（T4）、气腹结束后15min（T5）测量眼内压（intraocular pressure，IOP），同时观测各时点平均动脉压（mear anterial pressure，MAP）、心率（heart rat，HR）、呼出终未CO2分压（end tidal CO2 pressure，PETCO2）、气道压（ariway pressure，PAW）的变化。结果与Ⅰ组相比，Ⅱ组T1、T2、T3时MAP、IOP降低（P＜0．05）。两组各时点的HR、PKTCO2、PAW的无统计学差异。结论雷米芬太尼能够缓和妇科腹腔镜术中患者眼内压的升高。

Objective To observe the effect of remifentanil on intraocular pressure during laparoscopic gynecologic operations. Methods Forty patients undergoing laparoscopie gynecologic operation under complete intravenous anesthesia were divided into two groups randomly：group Ⅰ （control） and group Ⅱ （remifentanil） . Group Ⅰ： Anesthesia was induced with midazolam, propofol, vecuronium and fentanyl and maintained with continuous infusion of propel. Group Ⅱ ：maintained with continuous infusion of remifentanil to replace the fentanyl,the others were same as group Ⅰ. The intraocular pressure was detected by Tono-Pen XL Tonometer at the time points of 5 min after anesthesia induction（ T0 ） , 5 min after artificial pneumoperitoneum（ T1 ）, 15 min after artificial pneumoperitoneum（T2 ）, 5 min before the end of artificial pneumoperitoneum（T3 ）, 5 min after the end of artificial pneumoperitoneum（ T4 ） and 15 min after the end of artificial pneumoperitoneum（T5 ）, MAP,HR,PETCO2 and PAW be recorded at the same time. Results Compared to the group Ⅰ , MAP and IOP of the group Ⅱ at T1 , T2 and T3 were decreased significantly （ P 〈 0.05 ）. There were no significant differences in HR, PETCO2 ,PAW between two groups at all time points. Conclusion Remifentanil can obtund the increase in IOP during laparoscopic gynecologic operations.