右美托咪定对腹腔镜胃切除术患者眼内压的影响

Effect of dexmedetomidine on intraocular pressure during laparoscopic gastrectomy

目的 评价右美托咪定对腹腔镜胃切除术患者眼内压的影响.方法 择期行腹腔镜胃切除术患者40例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄34 ～ 64岁,体重45～81 kg,采用随机数字表法,将其分为2组（n=20）：对照组（C组）和右美托咪定组（D组）.D组先静脉输注负荷量右美托咪定1μg/kg 15 min,然后持续静脉输注0.4 μg·kg-·h-1至术毕;C组先静脉输注生理盐水0.25 ml/kg 15 min,然后持续静脉输注0.1ml·kg-1 ·h-1至术毕.静脉注射异丙酚、舒芬太尼和罗库溴铵麻醉诱导,气管插管后行间歇正压通气,维持PETCO2 33 ～ 36 mmHg.吸入七氟醚,静脉输注异丙酚、苯磺酸顺阿曲库铵和舒芬太尼维持麻醉.术中二氧化碳气腹压力维持9～ 14 mmHg,气道压维持11 ～ 23 cmH2O.分别于气管插管后5 min（T1）、CO2气腹5、30、60 min时（T2-4）、气腹结束后5、30 min（T5.6）时测量眼内压.结果 与T1时比较,C组T2-6时眼内压升高,D组T3-5时眼内压升高（P＜0.05）;与C组比较,D组T3-5时眼内压降低（P＜0.05）.结论 右美托咪定可降低腹腔镜胃切除患者眼内压.

Objective To evaluate the effect of dexmedetomidine on the intraocular pressure during laparoscopic gastrectomy.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 34-64 yr,weighing 45-81 kg,scheduled for elective laparoscopic gastrectomy,were randomly divided into 2 groups with 20 patients in each group using a random number table：control group （group C） and dexmedetomidine group （group D）.In group D,a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min,followed by continuous infusion of dexmedetomidine at 0.4 μg·kg-1 · h-1 until the end of surgery.In group C,normal saline 0.25 ml/kg was infused intravenously over 15 min,followed by continuous infusion of normal saline at 0.1 ml·kg-1 · h-1 until the end of surgery.Anesthesia was induced with propofol,sufentanil and rocuronium.After tracheal intubation,intermittent positive pressure ventilation was carried out.PET CO2 was maintained at 33-36 mmHg.Anesthesia was maintained with sevoflurane,propofol,cisatracurium and sufentanil.The pressure of carbon dioxide insufflation was maintained at 9-14 mmHg and airway pressure was maintained at 11-23 cmH2O.Intraocular pressure was measured at 5 min after intubation （T1）,at 5,30 and 60 min of pneumoperitoneum （T2-4）,and at 5,30 and 60 min after pneumoperitoneum （T5-6）.Results Compared with the value at T1,intraocular pressure was significantly increased at T2-6 in group C,and intraocular pressure was increased at T3-5 in group D.Intraocular pressure was significantly lower at T3-5 in group D than in group C.Conclusion Dexmedetomidine can decrease the intraocular pressure during laparoscopic gastrectomy.