小剂量右美托咪定对妇科腹腔镜手术患者眼内压的影响

Effects of low dosage of dexmedetomidine on the intraocular pressure in gynecological laparoscopic surgery

目的观察小剂量右美托咪定对妇科腹腔镜手术患者眼内压（IOP）的影响。方法择期全麻下行妇科腹腔镜手术患者60例,年龄18~64岁,ASAⅠ或Ⅱ级,BMI 18~22kg/m2,随机分为两组：右美托咪定组（D组）和对照组（C组）,每组30例。D组患者麻醉诱导前10min内静脉输注右美托咪定0.4μg/kg,C组给予等容量生理盐水。记录麻醉前（基础值,T0）、麻醉诱导后5 min（T1）、气腹5min（T2）、体位改变后5min（T3）、体位改变后30min（T4）、气腹60min（T5）和气腹结束后10min（T6）时IOP和CVP;计算眼灌注压,记录术中高眼压（眼内压〉21 mm Hg）的发生情况。结果与T0时比较,T1时两组IOP、眼灌注压及CVP明显降低,T2~T5时C组IOP和CVP明显升高、眼灌注压明显降低（P〈0.05）。与C组比较,T2~T5时D组IOP明显降低,眼灌注压明显升高,T3~T5时D组CVP和高眼压的发生率明显降低（P〈0.05）。结论静脉输注右美托咪定0.4μg/kg可有效减轻妇科手术患者气腹及体位因素导致的IOP升高。

Objective To investigate the effects of low dosage of dexmedetomidine on the in traocular pressure（IOP） during gynecological laparoscopie surgery. Methods Sixty patients of ASA I or Ⅱ, aged 18-64 years old, undergoing gynecological laparoseopic surgeries, were randomly divid- ed into 2 groups（n： 30 each）： dexmedetomidine group （group D） and control group （group C）. Group D received 0. 4μg/kg dexmedetomidine before induction, while group C received the same a- mount of saline. IOP,CVP, HR and MAP were recorded before induction（T0）, at 5 min after tracheal intubation（T1）, 5 rain after start of CO2 pneumoperitoneum（T2）, 5 min（Ts） and 30 rain（T4） after body position changed, 60 min after start of CO2 pneumoperitoneum and 10 min after end of CO2 pneumperitoneum. Incidences of hypertension （IOP〉21 mm Hg） were also recorded. Results Com- pared with To, IOP , CVP and irrigate pressure of eye at T1 were significantly decreased in group D and group C, IOP and CVP at T2-T5 were significantly increased and irrigate pressure of eye was de- creased in group C（P〈0.05）. Compared with group C, IOP at T2-T5, and CVP at T3-Ts were signif- icantly decreased in group D, and the incidence of intraocular hypertension was also decreased （P〈 0.05）. Conclusion Dexmedetomidine can effectively prevent the intraocular hypertension during gyne- cological laparoscopic surgery.