目的 探讨右美托咪定对腹腔镜下妇科恶性肿瘤根治术患者视神经鞘直径(ONSD)的影响。方法 本研究为单中心、前瞻性、随机、双盲、对照临床试验。纳入2022-11至2023-06在解放军总医院第七医学中心行腹腔镜下妇科恶性肿瘤根治术的患者62例,采用随机数字表法分为试验组和对照组,每组31例。两组患者麻醉诱导方案一致,试验组麻醉诱导后静脉给予右美托咪定负荷剂量1 μg/kg,持续泵注10 min,然后以0.4 μg/(kg·h)持续泵注至手术结束前30 min;对照组给予等容量生理盐水。记录患者的年龄、身高、体重、ASA分级、麻醉时间、手术时间、输液量、出血量、拔管时间、住院时间;测量两组患者麻醉诱导后(T0)、泵入右美托咪定负荷剂量后(T1)、气腹10 min(T2)、30 min(T3)、1 h(T4)、2 h(T5)、3 h(T6)及改回平卧位并关闭气腹后10 min (T7) 各时点的ONSD、平均动脉压(MAP)、心率(HR);并记录两组患者术中发生心动过缓、术后3 h内恶心呕吐及头痛的发生情况。结果 试验组T2至T7时点的ONSD均小于对照组,差异有统计学意义(P<0.05)。试验组T1、T3-6时点的MAP高于对照组,差异有统计学意义(P<0.05)。试验组T1,T5-7时点的HR低于对照组,差异有统计学意义(P<0.05)。试验组术后3 h内头痛的发生率为3.2%(1/31),低于对照组的29.0%(9/31),差异有统计学意义(P<0.05)。结论 右美托咪定可有效减缓腹腔镜下妇科恶性肿瘤根治术患者ONSD的增加,降低术后头痛的发生率。
Abstract
Objective To investigate the effect of dexmedetomidine on optic nerve sheath diameter (ONSD) in patients undergoing laparoscopic radical surgery for gynecological malignant tumors. Methods The study was a single-center, prospective, randomized, double-blind and controlled clinical trial. A total of 62 patients who underwent laparoscopic radical surgery for malignant tumors in the Seventh Medical Center of PLA General Hospital from November 2022 to June 2023 were included in the study, and were divided into the experimental group (n=31) and the control group (n=31) using the randomized numerical table method. The anesthesia induction protocols for the two groups were the same. After anesthesia induction, the patients in the experimental group were given a loading dose of dexmedetomidine of 1 μg/kg intravenously for 10 min, followed by continuous infusion of 0.4 μg /(kg·h) until 30 min before the end of surgery, while the patients in the control group were given an equal volume of saline. Data of age, height, weight, ASA classification, anesthesia time, operation time, infusion volume, bleeding volume, extubation time and hospital stay were recorded. ONSD values, mean arterial pressure (MAP), and heart rate (HR) were measured after induction of anaesthesia (T0), after a loading dose of dexmedetomidine infusion (T1), 10 min (T2), 30 min (T3), 1 h (T4), 2 h (T5), 3 h (T6) after pneumoperitoneum and 10 min after the recovery of supine position and the cease of pneumoperitoneum (T7). Occurrence of intraoperative bradycardia, nausea and vomiting, and headache within 3 h after surgery were recorded in both groups. Results The ONSD levels of the experimental group were statistically smaller than those of the control group at time points of T2-7 (P<0.05). The MAP of the experimental group was significantly higher than that of the control group at the time points of T1 and T3-6 (P<0.05). HR of the experimental group was statistically lower than that of the control group at time point of T1 and T5-7 (P<0.05). The incidence of headache within 3 h after surgery in the experimental group was 3.2% (1/31), which was statistically lower than that of 29.0% (9/31) in the control group (P<0.05). Conclusions Dexmedetomidine can effectively reduce the increase of ONSD as well as the incidence of postoperative headache in patients undergoing laparoscopic radical surgery for gynecological malignant tumors.
关键词
右美托咪定 /
视神经鞘直径 /
头低脚高位 /
腹腔镜手术 /
气腹
Key words
dexmedetomidine /
optic nerve sheath diameter /
head-down position /
laparoscopic surgery /
pneumoperitoneum
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基金
北京市住院医师规范化培训质量提高项目(科教处2022jy022)
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