非去极化肌松药对眼压升高的青光眼患者全身麻醉诱导期眼压的影响

Effects of non-depolarizing muscle relaxants on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia

目的:探讨全身麻醉诱导期应用不同种类的非去极化肌松药罗库溴铵、顺式阿曲库铵和米库氯铵对眼压升高的青光眼患者眼内压的影响。方法:将术侧眼眼压>21 mmHg青光眼手术患者随机分配到罗库溴铵组、顺式阿曲库铵组和米库氯铵组。靶控输注丙泊酚至患者脑电双频指数(bispectral index,BIS)低于55后,根据组别分别静注0.6 mg/kg罗库溴铵、0.1 mg/kg顺式阿曲库铵及0.2 mg/kg米库氯铵,待4个成串刺激(train of four stimulation,TOF)比值降至0后置入可弯曲喉罩,随后行机械通气并给予芬太尼1.5~2.0μg/kg,2%~3%七氟烷吸入维持麻醉。分别于麻醉诱导前(T)、镇静后(T)、肌松后(T)及喉罩置入后(T3)测量三组青光眼患者术侧眼眼压并记录上述时间点血流动力学参数。结果:罗库溴铵组、顺式阿曲库铵组、米库氯铵组患者的眼压在T、T、T时间点均较T0显著下降,差异有统计学意义(均P<0.001);三组患者T时间点眼压与T相比差异均无统计学意义(P=0.337,P=0.520,P=0.062);三组患者给予肌松药前后的眼压差值(T-T)分别为(0.68±4.39)、(0.36±3.72)和(1.27±3.91) mmHg,组间比较差异无统计学意义(P=0.353)。结论:非去极化肌松药罗库溴铵、顺式阿曲库铵及米库氯铵对眼压升高的青光眼患者的眼压无明显影响,且3种肌松药之间未见显著差异。

Objective:To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia.Methods:Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group,cis-atracurium group and mivacurium group.After target controlled infusion of propofol until the bispectral index(BIS) lower than 55,0.6 mg/kg rocuronium,0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups.The flexible laryngeal mask was placed after the train-of-four stimulation(TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately.General anesthesia was maintained by 1.5-2.0 μg/kg fentanyl and 2%-3% sevoflurane.Intraocular pressure and hemodynamic parameters were measured before anesthesia induction(T),after sedation(T),after muscle relaxation(T),and after laryngeal mask insertion(T).Results:The intraocular pressure of patients in rocuronium group,cis-atracurium group and mivacurium group at T,T, Twere lower than baseline(T),and the difference was statistically significant(P<0.001);There was no significant difference in intraocular pressure at Tcompared with Tin rocuronium group,cis-atracurium group and mivacurium group(P=0.337,P=0.520 and P=0.062 respectively);The difference of intraocular pressure between Tand Tin rocuronium group,cis-atracurium group and mivacurium group were(0.68±4.39),(0.36±3.72)and(1.27±3.91) mmHg respectively and there was no significant difference among the groups(P=0.353).Conclusion:The non-depolarizing muscle relaxants rocuronium,cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure,and there is no significant difference among the three muscle relaxants.