异丙酚与地氟醚用于妇科腹腔镜手术麻醉的比较

Comparison of propofol or desflurane in patients undergoing gynecological laparoscopic surgery

目的研究妇科腹腔镜术中异丙酚与地氟醚对平均动脉压(MAP)、心率(HR)、疼痛视觉模拟量表(VAS)评分、眼内压(IOP)的影响。方法选取择期行腹腔镜妇科手术的患者46例,按照随机数字表法分为两组:异丙酚组和地氟醚组,每组各23例(n=23)。气管插管后两组分别以异丙酚或地氟醚复合瑞芬太尼维持麻醉,比较麻醉前(基础值,T1)、麻醉诱导后5 min(T2)、气腹5 min(T3)、体位改变后5 min(T4)、体位改变后30min(T5)、气腹60 min(T6)和气腹结束后10 min(T7)各时间点MAP、HR、VAS评分、IOP,记录术中高眼压的发生率,观察患者手术中及麻醉恢复期不良事件发生情况。结果T1时间点两组患者MAP、HR、VAS评分、IOP比较,差异均无统计学意义(P>0.05)。与T1时间点比较,T3~T6时间点地氟醚组IOP明显升高,差异有统计学意义(P<0.05)。与地氟醚组比较,T3~T6时间点异丙酚组IOP明显降低,差异有统计学意义(P<0.05),T4~T6时间点异丙酚组高眼压的发生率明显降低,差异有统计学意义(P<0.05)。两组患者手术中及麻醉恢复期均为发生严重不良事件。结论异丙酚可有效降低妇科腹腔镜手术患者IOP的升高。

Objective To observe the effects of propofol or desflurane on mean arterial pressure(MAP),heart rate(HR),Visual Analogue Scale(VAS)scores and intraocular pressure(IOP)in patients undergoing gynecologic laparoscopic surgery.Methods 46 patients who undergoing elective laparoscopic gynecologic surgery were randomly divided into two groups:propofol group and desflurane group,with 23 cases in each group(n=23).Anaesthesia was induced with propofol or desflurane combined with target-controlled infusion(TCI)of remifentanilin each group,respectively.MAP,HR,VAS scores and IOP were compared at at before induction(T1,baseline),at 5 min after tracheal intubation(T2),5 min after start of CO2 pneumoperitoneum(T3),5 min(T4)and 30 min(T5)after body position changed,60 min(T6)after start of CO2 pneumoperitoneum and 10 min after end of CO2 pneumperitoneum(T7),respectively.The incidences of intraocular hypertension and adverse events were observed during surgery and anesthesia recovery period.Results There were no significant differences in MAP,HR,VAS scores and IOP between the two groups at T1(P>0.05).Compared with T1,the IOP of the desflurane group was significantly increased at T3~T6(P<0.05).Compared with the desflurane group,the IOP of the propofol group was significantly decreased at T3~T6(P<0.05),and the incidences of intraocular hypertension were significantly decreased in the propofol group at T4~T6(P<0.05).No severe adverse events occurred in the two groups during surgery and anesthesia recovery period.Conclusion Propofol can effectively reduce the elevation of IOP in patients undergoing gynecological laparoscopic surgery.