青光眼患者在异丙酚复合芬太尼和罗库溴铵诱导麻醉下眼压的变化  

Changes of intraocular pressure in glaucoma patients received induced anesthesia with propofol combined with fentanyl and rocuronium

作　　者：曹红[1] 李梦玮 陈宇虹[2] 孟樊荣[2] 钱韶红[2] 余晓波[2] 孙兴怀[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院护理部,上海200031 [2]复旦大学附属眼耳鼻喉科医院眼科卫生部近视眼重点实验室,上海200031

出　　处：《中国眼耳鼻喉科杂志》2016年第4期251-254,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的 通过对同一抗青光眼手术患者进行异丙酚复合芬太尼和罗库溴铵诱导麻醉前后眼压（IOP）的测量,观察青光眼患者在麻醉诱导复合用药下IOP的变化。方法 对20例需行抗青光眼手术的患者进行诱导麻醉：异丙酚2~3 mg/kg、芬太尼2~3μg/kg和罗库溴铵0.5 mg/kg。选取近期未行眼部手术眼,用Tono-Pen XL眼压计分别于诱导麻醉前、诱导后1 min和诱导后5 min行IOP测量,比较诱导前后IOP变化;并评估较低IOP组[IOP≤25 mm Hg（1 mm Hg=0.133 k Pa）]、中等IOP组（2535 mm Hg）患者在诱导麻醉后IOP的变化幅度。结果 诱导麻醉后1 min,平均IOP[（17.33±8.63）mm Hg]较诱导前[（29.60±10.38）mm Hg]明显降低（P〈0.001）,下降41.4%[SD=5.51,95%可信区间（CI）为10.31~14.22];诱导后5 min,平均IOP[（15.91±8.00）mm Hg]同样明显低于诱导前（P〈0.001）,下降46.3%（SD=5.47,95%CI为11.75~15.63）。IOP相对高的组比IOP相对低的组在诱导后1 min和5 min分别较诱导前IOP下降绝对值大[P=0.006（诱导1min,较高IOP组vs较低IOP组）;P=0.034（诱导1 min,中等IOP组vs较低IOP组）;P〈0.001（诱导5 min,较高IOP组vs较低IOP组）和P=0.004（诱导5 min,中等IOP组vs较低IOP组）]。但不同IOP组患者诱导后1 min和5 min分别较诱导前IOP下降百分比均数差异无统计学意义（P值分别为0.709和0.601）。结论 青光眼患者在异丙酚复合芬太尼和罗库溴铵诱导麻醉下IOP显著降低,且基础IOP较高的患者在诱导后IOP下降绝对值更大,但下降百分比与基础IOP较低患者相似,提示临床眼科医师需关注全身麻醉药物对青光眼患者IOP的影响。（中国眼耳鼻喉科杂志,2016,16：251-254）Objective To investigate the changes of intraocular pressure （IOP） in glaucoma patients administered propofol combined with fentanyl and rocuronium during general anesthesia surgeries. Methods Twenty patients received induced anesthesia with propofol 2 - 3 mg/kg, fentanyl 2 - 3 I.tg/kg and rocuronium 0.5 mg/kg for antiglaucoma surgery, lOP was measured in 33 eyes with Tono-Pen XL tonometer before anesthesia induction, 1 minute and 5 minutes after anesthesia induction. All patients were assigned into lower IOP （IOP ≤ 25 mm Hg） group, medium IOP （25 mm Hg 〈IOP≤35 mm Hg） group and higher IOP （IOP 〉35 mm Hg） group. And the changes of IOP in different groups were observed. Results The mean IOP was significantly lower at 1 minute after anesthesia induction [ （ 17.33 ± 8.63 ） mmHg ] than before induction [ （29.60 ± 10.38） mm Hg ] （P 〈 0.001 ）, with reduction of 41.4% （SD = 5.51, 95% CI = 10.31 - 14.22） ; the mean IOP was also significantly lower at 5 minutes after induction [ （ 15.91 ± 8.00） mm Hg] than before induction （P 〈0.001 ）, with reduction of 46.3% （SD = 5.47, 95% C1 = 11.75 - 15.63）. The absolute values of reduced IOP at 1 minute and 5 minutes after induction were larger in relatively higher lOP group than those in relatively lower IOP group [P =0. 006 （1 minute after induction, higher IOP group vs lower IOP group）; P =0. 034 （ 1 minute after induction, medium IOP group vs lower IOP group） ; P 〈 0. 001 （5 minutes after induction, higher lOP group vs lower IOP group ） and P = 0. 004 （ 5 minutes after induction, medium IOP group vs lower IOP group） ]. However, the percentage of reduced IOP at 1 minute and 5 minutes after induction was similar in different IOP groups （P =0.709, 0.601 respectively）. Conclusions The IOP in glaucoma patients was significantly reduced under general anesthesia with propofol combined with fentanyl and rocuronium. The absolute value of reduced IOP was larger was similar in higher IOP patients to that in lowe

关 键 词：诱导麻醉 眼压 青光眼 

分 类 号：R614[医药卫生—麻醉学]