Page 99 - 《中国药房》2022年17期

不同剂量右美托咪定对妇科腹腔镜手术患者颅内压的影响

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张惠灵 ，岳 维 ，关雨斐 ，许婷婷（1.山西医科大学麻醉学院，太原 030001；2.山西医科大学第二医院麻醉
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科，太原 030001）
中图分类号 R969；R614 文献标志码 A 文章编号 1001-0408（2022）17-2137-05
DOI 10.6039/j.issn.1001-0408.2022.17.18

摘 要 目的 考察不同剂量右美托咪定对妇科腹腔镜手术患者颅内压的影响。方法 将择期行妇科头低脚高体位腹腔镜手术的
90例患者按照随机数字表法分为低剂量试验组（D1组）、高剂量试验组（D2组）与对照组（C组），每组各30例。患者入室后，D1、
D2组患者均先按1.0 μg/kg的剂量静脉泵注右美托咪定10 min进行麻醉诱导，之后分别以0.4 μg/（kg·h）和0.6 μg/（kg·h）的速率继
续静脉泵注；C组患者持续泵注等容量氯化钠注射液。3组患者均于手术结束前30 min停止泵注。观察患者入室时（T0 ）、静脉泵
注右美托咪定10 min时（T1 ）、气腹10 min时（T2 ）、气腹30 min时（T3 ）、气腹60 min时（T4 ）、关闭气腹恢复平卧位10 min时（T5 ）的心
率（HR）、平均动脉压（MAP），同时超声测量各时间点患者双眼视神经鞘直径（ONSD），并记录术中发生心动过缓及使用阿托品的
情况。结果 3组患者在T0的ONSD、HR、MAP比较，差异均无统计学意义（P＞0.05）。与T0比较，3组患者在T1的ONSD均显著减
小（C 组除外），在 T2～T5的 ONSD 均显著增大且 MAP 和 HR 均显著降低（P＜0.05）；D2 组患者在 T1的 HR 也显著降低（P＜0.05）。
与C组比较，D1、D2组患者在T1～T5的ONSD均显著减小，HR均显著降低（P＜0.05）。与C组比较，D1、D2组发生心动过缓和使
用阿托品的患者数量明显增加（P＜0.05）。结论 在妇科腹腔镜手术中持续静脉泵注右美托咪定可以减少患者颅内压的增加，且泵
注速率0.4 μg/（kg·h）较0.6 μg/（kg·h）更能使患者HR的变化趋于稳定。
关键词 右美托咪定；腹腔镜手术；视神经鞘直径；颅内压；头低脚高体位；妇科

Effects of different doses of dexmedetomidine on intracranial pressure in patients undergoing gynecological
laparoscopic surgery
ZHANG Huiling ，YUE Wei ，GUAN Yufei ，XU Tingting （1. School of Anesthesiology， Shanxi Medical
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University，Taiyuan 030001，China；2. Dept. of Anesthesiology，the Second Hospital of Shanxi Medical
University，Taiyuan 030001，China）
ABSTRACT OBJECTIVE To investigate the effects of different doses of dexmedetomidine on intracranial pressure in patients
undergoing gynecological laparoscopic surgery. METHODS Ninety patients undergoing selective gynecological laparoscopic surgery
in trendelenburg position were divided into low-dose experimental group（group D1），high-dose experimental group（group D2）
and control group（group C）according to random number table，with 30 cases in each group. Group D1 and group D2 received
continuous intravenous infusion of dexmedetomidine 1.0 μ g/kg for 10 min for induction of anesthesia，and then continued
intravenous infusion at the rate of 0.4 μg/（kg·h）and 0.6 μg/（kg·h）respectively. Group C was continuously pumped with the
constant volume of Sodium chloride injection. Three groups stopped pumping 30 minutes before the end of the operation. The heart
rate（HR）and mean arterial pressure（MAP）were recorded when entering the room（T0 ），10 min after intravenous pump of
dexmedetomidine（T1 ），10 min（T2 ），30 min（T3 ），60 min（T4 ）after pneumoperitoneum，10 min after pneumoperitoneum was
closed to restore the supine position（T5 ）. At the same time，optic nerve sheath diameter（ONSD）in both eyes was measured by
ultrasound，and the occurrence of intraoperative bradycardia and the use of atropine were recorded. RESULTS There was no
statistical significance in ONSD，HR or MAP among 3 groups at T0 （P＞0.05）. Compared with T0，ONSD of 3 groups were
decreased significantly at T1（except for group C）；ONSD of 3 groups were increased significantly at T2-T5，while MAP and HR
were all decreased significantly（P＜0.05）. HR of group D2 was decreased significantly at T1（P＜0.05）. Compared with group C，
ONSD and HR of group D1 and D2 were all decreased significantly at T1-T5（P＜0.05）. Compared with group C，the number of
patients with bradycardia and those who used atropine in group D1 and D2 were increased significantly （P＜0.05）.
CONCLUSIONS Continuous pumping of dexmedetomidine during gynecologic laparoscopic surgery can reduce the increase of
intracranial pressure in patients；compared with pumping rate of 0.6 μg/（kg·h），the change of patient’s HR tends to be more stable
with a pumping rate of 0.4 μg/（kg·h）.
KEYWORDS dexmedetomidine； laparoscopic surgery； optic nerve sheath diameter； intracranial pressure； trendelenburg
position；gynaecology
＊第一作者 硕士研究生。研究方向：麻醉与围术期器官保护。
妇科腹腔镜手术需要 CO2气腹和患者头低脚高体
E-mail：911805175@qq.com
# 通信作者 副主任医师，硕士生导师，博士。研究方向：麻醉与围 位的配合来满足手术视野和操作空间需求，而两者均可
术期器官保护。E-mail：45889535@qq.com 能引起患者颅内压增高，进而导致相关并发症，影响患

中国药房 2022年第33卷第17期 China Pharmacy 2022 Vol. 33 No. 17 ·2137 ·