异丙酚、瑞芬太尼配伍对腹腔镜胆囊切除手术病人眼压的影响

目的:探讨全身麻醉下异丙酚、瑞芬太尼配伍对腔镜胆囊切除手术病人眼压的影响。方法:选择40例腹腔镜下单纯胆囊切除手术病人,术前无眼科及其他合并症。随机等分为两组P组(异丙酚组)和S组(七氟醚组),常规诱导麻醉,气管插管,P组配伍应用异丙酚和瑞芬太尼组维持全身麻醉,S组联合应用七氟醚和瑞芬太尼组维持全身麻醉。观察麻醉前(T0)、气管插管后(T1)、气腹后20min(T2)、气腹解除后(T3)不同时点上测病人的眼压(IOP)、心率(HR)、平均动脉压(MAP)、呼吸末CO2分压(PETCO2)的变化。结果:与T0时间点比较时,T1、T2各时间点病人的MAP、HR均下降(P>0.05);同时间点两组比较无显著性差异(P>0.05)。术中两组病人PETCO2均在正常范围,两组之间比较也无显著性差异(P>0.05)。各组内与T0指标相比,T1、T2各时间点病人的IOP均有所上升(P<0.05)。在T1、T2时间点S组较P组IOP上升显著(P<0.05)。结论:腹腔镜胆囊切除手术应用异丙酚、瑞芬太尼配伍麻醉降低患者IOP的作用明显优于七氟醚、瑞芬太尼联合麻醉。

Effects of Remifentanil and propofol for combined anesthesia on intraocular pressuresin patients during the simple laparoscopic cholecystectomy

Objective：To observe the effects of propofol and remifentanil combined application on intraocular pressure of laparoscopic cholecystectomy patients under general anesthesia.Methods：40 cases of simple laparoscopic cholecystectomy patients without ophthalmic and other complications preoperative,were randomly devided into 2 groups（n=20）：the P group（propofol group）,and the S group（sevoflurane group）.Routin anesthesia induction and endotracheal intubation,the P group combined with propofol and remifentanil to maintain general anesthesia and the S group combined with sevoflurane and remifentanil.To observe the change of patient＇s intraocular pressure（IOP）,heart rate（HR）,mean arterial pressure（MAP）,respiratory-CO2（PETCO2） at different time points：before anesthesia（T0）,after intubation（T1）,after 20 minutes of pneumoperitoneum（T2）,following the lifting of pneumoperitoneum（T3）.Results：the MAP,HR of patients at T1,T2 time point were both decreased compaired with that of T0,there was no significant difference between the two groups at the same time points（P0.05）,the patient＇s PETCO2 of both groups were in the normal range and had no statistical significance（P 0.05） when compared between the two groups,the patient＇s IOP at T1,T2 time points were increased（P 0.05） compared with that of T0 within each group,The patient＇s IOP of the S group were increased significantly（P 0.05） than the P group at the time point of T1,T2.Conclusion：Application of propofol and remifentanil for combined anesthesia in laparoscopic cholecystectomy to reduce the role of IOP in patients with better effect than sevoflurane and remifentanil for combined anesthesia.