右美托咪定联合瑞芬太尼对行气管内插管时眼内压的影响

发布时间：2018-03-16 06:44

本文选题：右美托咪定　切入点：瑞芬太尼　出处：《新疆医学》2016年10期 　论文类型：期刊论文

【摘要】：目的观察不同麻醉药物的组合对IOP的影响,探讨最佳组合方式。方法择期行鼻内镜手术患者60例,ASA分级I~Ⅱ级,随机分为4组:Y1组(右美托咪定0.4μg/kg+瑞芬太尼4ng/ml,n=15例),Y2组(右美托咪定0.4μg/kg+瑞芬太尼6ng/ml,n=15例),Y3组(右美托咪定0.6μg/kg+瑞芬太尼4ng/ml,n=14例),Y4组(右美托咪定0.6μg/kg+瑞芬太尼6ng/ml,n=14例)。术前不使用任何术前麻醉用药,采用Schiotz眼压计测定IOP,麻醉诱导前Y1、Y2组给予右美托咪定0.4μg/kg,Y3、Y4组给予右美托咪定0.6μg/kg。静脉注射依托咪酯0.3mg/kg待睫毛反射消失,Y1、Y3组靶控输注血浆靶浓度为4 ng/ml瑞芬太尼,Y2、Y4组靶控输注血浆靶浓度为6ng/ml瑞芬太尼,NI大于50时静脉给予罗库溴铵0.6 mg/kg,辅助通气维持PET CO2在35~45mm Hg之间,经口明示气管插管。观察并记录给予右美托咪定前(T0)、给予右美托咪定后3min(T1)、给予瑞芬太尼前即刻(T2)、插管即刻(T3)、插管后5min(T4)的MAP、HR、IOP。结果 MAP、HR、IOP在T0、T1、T2三个时间点组内和组间比较差异无统计学意义,P0.05。与T0比较,在T3时间点四组患者在MAP、IOP与T0比较均有显著性差异,P0.05,组间比较差异无统计学意义,P0.05。在T3时间点,Y3组与Y4组在HR上与T0比较差异有显著性,P0.05。结论 0.4μg/kg的右美托咪定复合靶控输注血浆靶浓度4ng/ml瑞芬太尼就能够降低气管插管前IOP,并能够抑制由于插管引起的高眼压反应。该结果对于术前合并有高眼压的青光眼患者,以及眼外伤和近期实施过内眼手术的患者有临床指导意义。
[Abstract]:Objective to observe the effect of different anesthetic combinations on IOP and to explore the best combination method. They were randomly divided into 4 groups: group Y1 (right metoimidine 0.4 渭 g / kg remifentanil 4 ng / ml / ml) and group Y2 (15 cases with remifentanil 0.4 渭 g / kg / kg remifentanil 6 ng / ml / nng) in group Y3 (right metoimidine 0.6 渭 g / kg remifentanil / kg / 4 ngml / ml) in group Y4 (right metoimidine 0.6 渭 g / kg remifentanil 6ngmln-1). Use any preoperative anesthetic, Schiotz IOP was measured by Schiotz IOP. Before anesthesia induction, Y1TO Y2 group was given dexmetoimidine 0.4 渭 g / kg, Y3 + Y4 group was given dexmetomidine 0.6 渭 g / kg. etomidate 0.3 mg / kg was given before anesthesia induction. The target plasma target concentration of 4 ng/ml remifentanil and Y2OY4 group was treated with etomidate 0.3 mg / kg. Controlled infusion of plasma target concentration of 6 ng / ml remifentanil was administered intravenously with rocuronium 0.6 mg / kg when the concentration of remifentanil was greater than 50, and PET CO2 was maintained between 35 and 45 mm Hg. Ostensibly tracheal intubation. MAPHRIOPs were observed and recorded before and 3 mins after dexmetomidine administration, immediately before remifentanil administration, immediately after intubation, and 5 min after intubation. Results MAPHRIOP was measured within and between groups at three time points: T0 / T1 / T2. Compared with T0, the difference was not statistically significant (P 0.05). At T3 time point, there were significant differences in MAPIOP and T0 between the four groups (P 0.05), but there was no significant difference between the two groups (P 0.05). At T3 time point, there was a significant difference in HR between Y3 group and Y4 group compared with T0. Conclusion 0.4 渭 g / kg dexmemetodine has a significant difference between group Y3 and Y4. Combined target-controlled infusion of plasma target concentration of 4 ng / ml remifentanil could reduce IOP before tracheal intubation and inhibit the high IOP response caused by intubation. And the patients with ocular trauma and recent intraocular surgery are of clinical significance.
【作者单位】：新疆医科大学第一附属医院麻醉科;
【分类号】：R614

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