异丙酚复合瑞芬太尼麻醉对妇科腹腔镜手术患者眼内压的影响

目的 探讨异丙酚复合瑞芬太尼全身麻醉对妇科腹腔镜患者眼内压（IOP）的影响.方法 选择择期妇科腹腔镜手术患者60例,随机分为两组：P组（异丙酚复合瑞芬太尼组）和S组（七氟醚复合瑞芬太尼组）,常规全麻诱导,气管插管.麻醉维持：P组联合使用异丙酚和瑞芬太尼,S组联合使用七氟醚和瑞芬太尼.观察麻醉前（T0）、气管插管后（T1）、气腹后20min（T2）、气腹解除后10min（T3）4个时点患者平均动脉压（MAP）、心率（HR）、呼吸末CO2分压（PETCO2）、IOP的变化情况.结果 与T0相比,T1、T2时点两组患者的MAP、HR均下降（P＜0.05）;各时点组间比较,两组患者的MAP与HR比较无显著性差异（P＞0.05）.两组PETCO2均在正常范围内,组间比较无显著性差异（P＞0.05）.各组内与T0相比,T1、T2时点患者的IOP均有所上升（P＜0.05）,且T1、T2时点S组较P组IOP上升明显（P＜0.05）.结论 在妇科腹腔镜手术中,异丙酚复合瑞芬太尼全身麻醉降低患者IOP的作用明显优于七氟醚与瑞芬太尼复合麻醉.

Effects of Remifentanil and Propofol for Combined Aesthesia on Intraocular Pressures in Patients during Gynecological Laparoscopic Operation

Objective To observe the effects of propofol and remifentanil combined application on intraocular pressure of gynecological laparoscopic operation patients under general anesthe- sia.Methods 60 cases of gynecological laparoscopic operation patients without ophthalmic and other complications preoperative were randomly divided into 2 groups （n = 30） ：the P group （propofol group）,and the S group （sevoflurane group）.With normal anesthesia induction and endotracheal intubation, the P group combined with propofol and remifentanil to maintain general anesthesia and the S group combined with evoflurane and remifentanil. Observed were the change of patient＇s intraocular pressure （lOP）, heart rate （HR）, mean arterial pressure （ MAP）, respiratory-CO2（PETCO2） at different time points ： before anesthesia （T0）, after ifitubation （T1）, after 20 minutes of pneumoperitoneum （T2） ,following the lifting of pneumoperitoneum （T3）.Results The MAP, HR of patients at Ti ,T2 time points were both decreased compared with that of T0,there was no significant difference between the two groups at the same time points （P〈0.05）, the patient＇s PETCO= 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 was increased （P〈0.05） compared with that of TO within each group. The patient＇s lOP of the S group was increased significantly （P〈0.05） than the P group at the time point of T1,T2.Conclusion It is more effective to apply propofol and remifentanil to combined anesthesia in gynecological laparoscopic operation to reduce the role of lOP in patients than sevoflurane and remifentanil for combined anesthesia.