妇科腹腔镜手术右美托咪定滴鼻或静脉给药对患者眼内压及血流动力学影响  

Effects of intranasal or intravenous injection dexmedetomidine during gynecological laparoscopic surgery of patients on their intraocular pressure and hemodynamics

作　　者：张芳芳 左真文 ZHANG Fangfang;ZUO Zhenwen(Shanghai Eighth People's Hospital,Shanghai,200235;Shanghai Fifth People's Hospital,Shanghai)

机构地区：[1]上海市第八人民医院,200235 [2]上海市第五人民医院

出　　处：《中国计划生育学杂志》2023年第3期533-536,541,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨右美托咪定滴鼻或静脉给药对妇科腹腔镜手术患者眼内压(IOP)及血流动力学的影响。方法:选取2019年1月-2021年12月在本院择期接受妇科腹腔镜手术患者115例,随机数字表法分为右美托咪定滴鼻组(滴鼻组)、右美托咪定静脉注射组(静脉组)以及对照组共3组,滴鼻组(38例)给予右美托咪定(0.6μg/kg)滴鼻,静脉组(38例)给予持续静脉泵泵注右美托咪定(0.6μg/kg)注射液,对照组(39例)给予0.9%生理盐水滴鼻。观察和记录各组患者在麻醉诱导前(T0)、麻醉诱导后5 min(T1)、气管插管后5min(T2)、气腹并改变体位后30min(T3)、气管拔管时(T4)平均动脉压(MAP)、心率(HR)以及IOP情况,围手术期不良反应。结果:与T0相比,各组T1时MAP和IOP降低,HR减缓;T2~T4时MAP、IOP和HR水平对照组高于T0时,且对照组>滴鼻组>静脉组(均P<0.05)。高眼压发生率滴鼻组(5.3%)和静脉组(2.6%)均低于对照组(23.1%),而静脉组低血压(20.1%)和心动过缓(15.8%)发生率高于对照组(0、0)和滴鼻组(5.3%、2.6%)(均P<0.05)。结论:右美托咪定有助于稳定麻醉下妇科腹腔镜手术患者血流动力学并降低眼内压升高风险,且滴鼻给药相比静脉注射安全性更高。Objective:To investigate the effects of intranasal dexmedetomidine or intravenous injection dexmedetomi-dine during gynecological laparoscopic surgery of patients on their intraocular pressure(IOP)and hemodynamics.Methods:From January 2019 to December 2021,115 patients who wanted gynecological laparoscopic surgery were randomly divided into three groups by random number table method.The patients in group A were given intranasal dexmedetomidine(0.6μg/kg),the patients in group B were given continuous intravenous infusion of dexmedetomidine(0.6μg/kg),and the patients in group C were given intranasal 0.9%normal saline.The values of mean arterial pressure(MAP),heart rate(HR),and intra-ocular pressure(IOP),and the adverse reactions rate in the perioperative pe-riod of the patients in the three groups before anesthesia induction(T0),at 5 minutes after anesthesia induction(T1),at 5 minutes after tracheal intubation(T2),at 30 minutes after pneumoperitoneum and body position change(T3),and at tracheal extubation(T4)of the patients in the three groups were observed and recorded.Results:The values of MAP,OP,and HR of the patients in the three groups at T1 were significantly lower than those of the patients at T0.The values of MAP,IOP,and HR of the patients in groupC at T2-T4 were significantly higher than those at TO,and which of the patients in group C,group A,and group B had decreased gradually(all P<0.05).The incidence of ocular hypertension(5.3%or 2.6%)of the patients in group A or group B was significantly lower than that(23.1%)of the patients in group C,while the incidences of hypotension(20.1%)and bradycardia(15.8%)of the patients in group B were significantly higher than those(0 and 0)of the patients in group C and those(5.3%and 2.6%)of the patients in group A(all P<0.05).Conclusion:Dexmedetomidine is helpful to stabilize the hemodynamics of the patients during gynecologic laparoscopic surgery under anesthesia,and which can reduce the risk of the IOP elevating.Intranasal dexmedetomidine is safer than intravenous in

关 键 词：妇科腹腔镜手术 眼内压 右美托咪定 滴鼻 静脉 血流动力学 不良反应 

分 类 号：R614[医药卫生—麻醉学]