不同剂量右美托咪定对妇科腹腔镜手术患者颅内压的影响  

Effects of different doses of dexmedetomidine on intracranial pressure in patients undergoing gynecological laparoscopic surgery

作　　者：张惠灵 岳维[2] 关雨斐 许婷婷 ZHANG Huiling;YUE Wei;GUAN Yufei;XU Tingting(School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Dept.of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第二医院麻醉科,太原030001

出　　处：《中国药房》2022年第17期2137-2141,共5页China Pharmacy

摘　　要：目的考察不同剂量右美托咪定对妇科腹腔镜手术患者颅内压的影响。方法将择期行妇科头低脚高体位腹腔镜手术的90例患者按照随机数字表法分为低剂量试验组(D1组)、高剂量试验组(D2组)与对照组(C组),每组各30例。患者入室后,D1、D2组患者均先按1.0μg/kg的剂量静脉泵注右美托咪定10 min进行麻醉诱导,之后分别以0.4μg/(kg·h)和0.6μg/(kg·h)的速率继续静脉泵注;C组患者持续泵注等容量氯化钠注射液。3组患者均于手术结束前30 min停止泵注。观察患者入室时(T0)、静脉泵注右美托咪定10 min时(T_(1))、气腹10 min时(T_(2))、气腹30 min时(T_(3))、气腹60 min时(T_(4))、关闭气腹恢复平卧位10 min时(T_(5))的心率(HR)、平均动脉压(MAP),同时超声测量各时间点患者双眼视神经鞘直径(ONSD),并记录术中发生心动过缓及使用阿托品的情况。结果3组患者在T0的ONSD、HR、MAP比较,差异均无统计学意义(P>0.05)。与T0比较,3组患者在T_(1)的ONSD均显著减小(C组除外),在T_(2)~T_(5)的ONSD均显著增大且MAP和HR均显著降低(P<0.05);D2组患者在T_(1)的HR也显著降低(P<0.05)。与C组比较,D1、D2组患者在T_(1)~T_(5)的ONSD均显著减小,HR均显著降低(P<0.05)。与C组比较,D1、D2组发生心动过缓和使用阿托品的患者数量明显增加(P<0.05)。结论在妇科腹腔镜手术中持续静脉泵注右美托咪定可以减少患者颅内压的增加,且泵注速率0.4μg/(kg·h)较0.6μg/(kg·h)更能使患者HR的变化趋于稳定。OBJECTIVE To investigate the effects of different doses of dexmedetomidine on intracranial pressure in patients undergoing gynecological laparoscopic surgery.METHODS Ninety patients undergoing selective gynecological laparoscopic surgery in trendelenburg position were divided into low-dose experimental group(group D1),high-dose experimental group(group D2)and control group(group C)according to random number table,with 30 cases in each group.Group D1 and group D2 received continuous intravenous infusion of dexmedetomidine 1.0μg/kg for 10 min for induction of anesthesia,and then continued intravenous infusion at the rate of 0.4μg/(kg·h)and 0.6μg/(kg·h)respectively.Group C was continuously pumped with the constant volume of Sodium chloride injection.Three groups stopped pumping 30 minutes before the end of the operation.The heart rate(HR)and mean arterial pressure(MAP)were recorded when entering the room(T0),10 min after intravenous pump of dexmedetomidine(T_(1)),10 min(T_(2)),30 min(T_(3)),60 min(T_(4))after pneumoperitoneum,10 min after pneumoperitoneum was closed to restore the supine position(T_(5)).At the same time,optic nerve sheath diameter(ONSD)in both eyes was measured by ultrasound,and the occurrence of intraoperative bradycardia and the use of atropine were recorded.RESULTS There was no statistical significance in ONSD,HR or MAP among 3 groups at T0(P>0.05).Compared with T0,ONSD of 3 groups were decreased significantly at T_(1)(except for group C);ONSD of 3 groups were increased significantly at T_(2)-T_(5),while MAP and HR were all decreased significantly(P<0.05).HR of group D2 was decreased significantly at T_(1)(P<0.05).Compared with group C,ONSD and HR of group D1 and D2 were all decreased significantly at T_(1)-T_(5)(P<0.05).Compared with group C,the number of patients with bradycardia and those who used atropine in group D1 and D2 were increased significantly(P<0.05).CONCLUSIONS Continuous pumping of dexmedetomidine during gynecologic laparoscopic surgery can reduce the increase of intracranial

关 键 词：右美托咪定 腹腔镜手术 视神经鞘直径 颅内压 头低脚高体位 妇科 

分 类 号：R969[医药卫生—药理学] R614[医药卫生—药学]