妇科腹腔镜手术中眼内压增高的麻醉处理(1)
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2010年2月1日
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【摘要】目的:探讨降低妇科腹腔镜手术中眼内压增高的麻醉处理方法。 方法:66例ASAI~П级妇科腹腔镜手术患者,用Pono-Pen眼压计分别测量麻醉后5分钟,气腹后头低位15分钟,调高手术床背板,头垫高,滴噻吗心安眼药水5分钟,15分钟及气腹结束去枕平卧后5分钟,15分钟眼内压(IOP),同时观测SBP、DBP、HR的变化。结果:术中各时点SBP、DBP、HR差异无统计学意义,而通过以上处理后IOP能降到气腹前水平,有统计学意义。结论:调节上身及头高位并滴噻吗心安眼药水可以预防妇科腹腔镜IOP升高,预防视神经损伤。
【关键词】妇科腹腔镜; 眼内压; 麻醉处理
【中图分类号】R614 【文献标识码】C 【文章编号】1008-6455(2010)08-0126-02
The anesthetic treatment of hyper-intraocular pressure in gynecological laparoscopic operation
Zhao Jianli Wei Tao Wei Guowen Huang Wei Huang Weijun
【Abstract】Objective:To investigate the anesthetic treatment of degrading intraocular pressure in gynecological laparoscopic operation. Methods:We randomly selected 66 patients with Grade ASAI~П gynecological laparoscopic surgery. Intraocular pressure was detected by Pono-Pen applanometer in 5 minutes after anesthesia, 15 minutes after head down position of artificial pneumoperitoneum, 5 minutes and 15 minutes after reverse trendelenburg position and received timolol eye drop, 5 minutes and 15 minutes after prostration with artificial pneumoperitoneum ending. At the same time, we observed the SBP、DBP、HR.Results:The difference ofSBP、DBP、HR in each period in surgery did not have statistical significance. But IOP could decrease by the level of pro-pneumoperitoneum with above-mentioned treatment. The difference had statistical significance. Conclusion:upper body accommodation and reverse trendelenburg position and receiving timolol eyedrop can effectively prevent hyper-intraocular pressure in gynecological laparoscopic operation and optic nerve injury.
【Key words】Gynecological laparoscopic;Intraocular pressure;Anesthetic treatment
微创手术在妇科手术中的应用已日益广泛,腹腔镜手术治疗妇科疾病已经逐步代替以往的开腹手术,而妇科腹腔镜的头低位和人工气腹可以导致围术期的视力损害也开始引起麻醉医师的注意。 围手术期视力损害是灾难性的,可导致视力暂时性部分或全部缺失,直至永久性失眠,全麻术后此类并发症发生率高达1/61000[1],为此我们对我院妇科腹腔镜手术患者眼内压变化及处理过程报道如下。
1 资料与方法
1.1 一般资料:随机选择ASA评估I~II级妇科腹腔镜手术患者共66例,其中不孕症腹腔镜治疗18例,宫外孕11例,卵巢肿瘤9例,全宫切除19例,子宫及附件切除及淋巴结清扫9例。年龄在26-55岁,体重在45-67Kg,术前均无高血压、眼部疾病、糖尿病史。
1.2 方法:入室前30分钟肌注乙酰奎醚1mg,麻醉诱导,静注咪唑0.1mg/kg.舒芬太尼0.5 ug/kg依托咪酯0.3 mg/kg罗库溴铵0.6mg/kg气管插管后单纯静脉复合维持麻醉,微量泵持续输注丙泊酚5mg/kg/h,雷米芬太尼0.15mg/kg/h,每隔45分钟追加罗库溴铵0.3mg/kg。麻醉机呼吸参数VT8ml/kg,RR12次/分,呼吸比1∶2 ......
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