PRO和SEV麻醉对头低位妇科腹腔镜手术患者眼压的影响

Effects of PRO and SEV anesthesia on intraocular pressure in patients with gynecological laparoscopic surgery in head-down position

目的观察头低位妇科腹腔镜手术中运用丙泊酚(PRO)和七氟烷(SEV)麻醉对患者眼压的影响。方法60例行全身麻醉(全麻)头低位妇科腹腔镜手术患者,采用随机数字表法分成PRO组和SEV组,每组30例。PRO组在术中应用PRO和瑞芬太尼维持麻醉,SEV组在术中应用SEV和瑞芬太尼维持麻醉。比较两组各时间点[麻醉后平卧5 min(T0)、气腹后15 min(T1)、气腹后30 min(T2)、气腹后1 h(T3)、术毕平卧10 min(T4)]的眼压、心率、血压、二氧化碳分压以及术后3 d眼科不良事件发生情况。结果两组T1、T2、T3、T4时的眼压均高于本组T0时,但PRO组T1、T2、T3时的眼压(16.67±0.21)、(16.84±0.16)、(16.24±0.77)mm Hg(1 mm Hg=0.133 kPa)均低于SEV组的(18.15±0.47)、(19.23±0.19)、(19.45±0.43)mm Hg,差异具有统计学意义(P<0.05)。两组T1、T2、T3、T4时的心率、收缩压、舒张压均高于本组T0时,但PRO组低于SEV组,差异均有统计学意义(P<0.05);两组T1、T2、T3时的二氧化碳分压均高于本组T0时,但PRO组二氧化碳分压(38.06±1.57)、(40.76±0.66)、(40.84±0.12)mm Hg低于SEV组的(40.36±0.78)、(41.08±0.28)、(41.34±0.34)mm Hg,差异具有统计学意义(P<0.05)。PRO组的眼科不良事件发生率为6.667%,低于SEV组的26.67%,差异具有统计学意义(P<0.05)。结论PRO和SEV麻醉对头低位妇科腹腔镜手术眼压均有影响,其中PRO对眼压变化的影响更小,可避免患者在围术期眼压过度升高,减少术后眼科不良事件,同时有效控制心率、血压和二氧化碳分压。

Objective To observe the effect of propofol(PRO)and sevoflurane(SEV)anesthesia on intraocular pressure in patients with gynecological laparoscopic surgery in head-down position.Methods A total of 60 patients with head-down gynecological laparoscopic surgery under general anesthesia were divided into PRO group and SEV group by random numerical table,with 30 cases in each group.The PRO group received PRO and remifentanil for anesthesia maintenance,and the SEV group received SEV and remifentanil for anesthesia maintenance.Both groups were compared in terms of intraocular pressure,heart rate,blood pressure,partial pressure of carbon dioxide at different time points[5 min after anesthesia(T0),15 min after pneumoperitoneum(T1),30 min after pneumoperitoneum(T2),1 h after pneumoperitoneum(T3),and 10 min after surgery(T4)]and the occurrence of ophthalmic adverse events 3 d after surgery.Results The intraocular pressures at T1,T2,T3,and T4 in the two groups were higher than those at T0 in this group,but the intraocular pressures at T1,T2,and T3 in the PRO group were(16.67±0.21),(16.84±0.16),and(16.24±0.77)mm Hg(1 mm Hg=0.133 kPa),which were lower than(18.15±0.47),(19.23±0.19),and(19.45±0.43)mm Hg in SEV group,and the differences were all statistically significant(P<0.05).The heart rate,systolic blood pressure,and diastolic blood pressure at T1,T2,T3,and T4 in the two groups were higher than those at T0 in this group,but the PRO group was lower than the SEV group,and the differences were all statistically significant(P<0.05).The partial pressures of carbon dioxide at T1,T2,and T3 in the two groups were higher than those at T0 in this group,but the partial pressures of carbon dioxide in the PRO group were(38.06±1.57),(40.76±0.66),and(40.84±0.12)mm Hg,which were lower than(40.36±0.78),(41.08±0.28),and(41.34±0.34)mm Hg in the SEV group,and the differences were all statistically significant(P<0.05).The incidence of ophthalmic adverse events in the PRO group was 6.667%,which was lower than 26.67%in the SEV group,and the difference was statistically significant(P<0.05).Conclusion Both PRO and SEV anesthesia have an effect on intraocular pressure in gynecological laparoscopic surgery with head-down position.Among them,PRO has less influence on the change of intraocular pressure,which can prevent patients from excessively increasing intraoperative intraocular pressure during the perioperative period,reduce postoperative ophthalmic adverse events,and effectively control heart rate,blood pressure and partial pressure of carbon dioxide.