右美托咪定对妇科腹腔镜手术Trendelenburg体位患者视神经鞘直径的影响  

Effect of dexmedetomidine on optic nerve sheath diameter in patients undergoing gynecological laparoscopic surgery in Trendelenburg position

作　　者：钱美娟[1] 赵李红 谢阳 李慧 谢红[3] QIAN Meijuan;ZHAO Lihong;XIE Yang;LI Hui;XIE Hong(Department of Anesthesiology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou Municipal Hospital in Jiangsu Province,Suzhou,Jiangsu,215002;Department of Obstetrics,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou Municipal Hospital in Jiangsu Province,Suzhou,Jiangsu,215002;Department of Anesthesiology,the Second Hospital Affiliated to Soochow University,Suzhou,Jiangsu,215004)

机构地区：[1]南京医科大学附属苏州医院/江苏省苏州市立医院麻醉科,江苏苏州215002 [2]南京医科大学附属苏州医院/江苏省苏州市立医院妇产科,江苏苏州215002 [3]苏州大学附属第二医院麻醉科,江苏苏州215004

出　　处：《实用临床医药杂志》2022年第4期1-4,共4页Journal of Clinical Medicine in Practice

基　　金：江苏省自然科学基金资助项目(BK20190190)。

摘　　要：目的观察右美托咪定对妇科腹腔镜手术Trendelenburg体位患者视神经鞘直径(ONSD)的影响。方法选取行腹腔镜全子宫切除术患者60例为研究对象,随机分为右美托咪定组(n=30)和对照组(n=30)。右美托咪定组从麻醉诱导开始以0.4μg/(kg·h)连续泵注右美托咪定,直至患者恢复平卧位并关闭气腹10 min后,对照组采用相同方式泵注0.9%氯化钠溶液。测量2组麻醉诱导前5 min(T^(0))及气腹头低位10 min(T^(1))、30 min(T^(2))、60 min(T^(3))和改回平卧位并关闭气腹后10 min(T^(4))时ONSD、心率(HR)、平均动脉压(MAP)。比较2组术后3 h内恶心呕吐和头痛的发生情况。结果右美托咪定组在T^(1)至T^(4)共4个时点的ONSD均小于对照组,HR低于对照组,差异有统计学意义(P<0.05)。右美托咪定组术后3 h内恶心呕吐、头痛的发生率为20.00%、13.33%,分别低于对照组的46.67%、40.00%,差异有统计学意义(P<0.05)。结论在妇科腹腔镜手术中应用右美托咪定可有效减缓Trendelenburg体位患者的ONSD增大,降低术后恶心呕吐和头痛的发生率。Objective To observe the effect of dexmedetomidine on optic nerve sheath diameter(ONSD)in patients undergoing gynecological laparoscopic surgery in Trendelenburg position.Methods Sixty patients underwent laparoscopic total hysterectomy were selected as research objects.They were randomly divided into dexmedetomidine group(n=30)and control group(n=30).The dexmedetomidine group was continuous pumped 0.4μg/(kg·h)dexmedetomidine from anesthesia induction until patients were restored to horizontal position and pneumoperitoneum was closed for 10 min,and the control group was pumped with 0.9%sodium chloride solution in the same way.The ONSD,heart rate(HR)and mean arterial pressure(MAP)were measured at 5 min before induction of anesthesia(T^(0)) and 10 min(T^(1)),30 min(T^(2)) as well as 60 min(T^(3)) at the low level of pneumoperitoneum head and 10 min after conversion to horizontal position and pneumoperitoneum closure(T^(4)) in the two groups.The incidence of nausea,vomiting and headache within 3 hours after operation was compared between the two groups.Results The ONSD of the dexmedetomidine group was significantly less,and the HR was significantly lower than those of the control group at T^(1),T^(2),T^(3) and T^(4)(P<0.05).The incidence rates of postoperative nausea and vomiting as well as headache within 3 hours after operation in the dexmedetomidine group were 20.00%and 13.33%,which were significantly lower than 46.67%and 40.00%in the control group(P<0.05).Conclusion The application of dexmedetomidine can effectively reduce the ONSD increase of patients undergoing gynecological laparoscopic surgery in Trendelenburg position,and reduce the incidence of postoperative nausea and vomiting as well as headache.

关 键 词：右美托咪定 视神经鞘直径 头低脚高位 妇科 腹腔镜手术 

分 类 号：R246.3[医药卫生—针灸推拿学] R614[医药卫生—中医临床基础]