右美托咪定对全麻下成人扁桃体切除术患者视神经鞘直径的影响

Effect of dexmedetomidine on diameter of optic nerve sheath in adult patients undergoing tonsillectomy under general anesthesia

目的 观察在全麻下成人扁桃体切除术中应用右美托咪定对视神经鞘直径(ONSD)的影响 方法 纳入成人择期行扁桃体切除术患者60例,ASAⅠ~Ⅱ分级,随机分为右美托咪定组(D组)和对照组(C组),每组各30例,均在全麻气管插管下行扁桃体切除术,D组在诱导开始前10min持续泵入0.5μg/(kg·h)右美托咪定至手术结束,C组以同样的方式泵注生理盐水至手术结束,记录两组患者泵入药物前5min(T0)、摆放颈部过伸位后1min(T1)、摆放颈部过伸位后5min(T2)、置入开口器后1min(T3)、置入开口器后5min(T4)、取出开口器恢复平卧位5min(T5)时各时间点心率(HR)、平均动脉压(MAP)、视神经鞘直径(ONSD),记录手术时间、出血量、输液量、苏醒时间及心动过缓、恶心呕吐、头晕头疼不良反应的情况。结果 与T0时比较,T1-T5时两组ONSD均升高(P<0.05),T1-T5时间点D组HR、ONSD明显低于C组(P<0.05);两组患者在手术时间、出血量、输液量、苏醒时间上差异无统计学意义(P>0.05),不良反应的发生率差异无统计学意义(P>0.05)。结论 全麻下扁桃体切除术中颈部过伸位和置入开口器均会引起的视神经鞘直径增大,右美托咪定在一定程度上可缓解扁桃体切除术中患者视神经鞘直径增大,降低颅内压,术中循环功能平稳,无明显不良反应,值得临床借鉴。

Objective To observe the effect of dexmedetomidine on optic nerve sheath diameter(ONSD)in adults undergoing tonsillectomy under general anesthesia.Methods 60 adult patients undergoing elective tonsillectomy were enrolled.Dexmedetomidine group(group D)and control group(group C),30 cases in each group,underwent tonsillectomy under tracheal intubation under general anesthesia,and group D continued to pump 0.5μg/(kg·h)10 minutes before induction Dexmedetomidine was pumped to the end of the operation.Group C was pumped with normal saline in the same way until the end of the operation.The two groups of patients were recorded 5 minutes before the drug was pumped(T0)and 1 minute after the neck hyperextension was placed(T1).5 minutes after placing the neck hyperextension(T2),1 minute after inserting the mouthpiece(T3),5 minutes after inserting the mouthpiece(T4),and 5 minutes after removing the mouthpiece and returning to the supine position(T5).Rate(HR),mean arterial pressure(MAP),optic nerve sheath diameter(ONSD),operation time,blood loss,infusion volume,recovery time and adverse reactions such as bradycardia,nausea and vomiting,dizziness and headache were recorded.Results Compared with T0,ONSD in both groups increased at T1-T5(P<0.05),HR and ONSD in group D were significantly lower than those in group C at T1-T5 time point(P<0.05).There was no significant difference in bleeding volume,infusion volume and recovery time(P>0.05),and there was no significant difference in the incidence of adverse reactions(P>0.05).Conclusions The diameter of the optic nerve sheath increases due to neck hyperextension and insertion of an open gag during tonsillectomy under general anesthesia.Dexmedetomidine can alleviate the increase in the diameter of the optic nerve sheath in patients undergoing tonsillectomy to a certain extent.Reduce intracranial pressure,stable intraoperative circulatory function,no obvious adverse reactions,worthy of clinical reference.