[1]冀 玲,何印斌,刘凡凡,等.右美托咪定对超声乳化白内障吸除术患者血流动力学及应激反应的影响[J].陕西医学杂志,2022,51(8):1008-1012.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.024]
　JI Ling,HE Yinbin,LIU Fanfan,et al.Effect of dexmedetomidine on hemodynamics and stress response in patients undergoing phacoemulsification cataract extraction[J].,2022,51(8):1008-1012.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.024]
点击复制

右美托咪定对超声乳化白内障吸除术患者血流动力学及应激反应的影响
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年8期
页码:
1008-1012
栏目:
药物与临床
出版日期:
2022-08-05

文章信息/Info

Title:
Effect of dexmedetomidine on hemodynamics and stress response in patients undergoing phacoemulsification cataract extraction
作者:
冀 玲; 何印斌; 刘凡凡; 杨舟静
(西安市人民医院 西安市第四医院麻醉与围术期医学中心,陕西 西安 710004)
Author(s):
JI Ling; HE Yinbin; LIU Fanfan; YANG Zhoujing
(Anesthesia and Perioperative Medicine Center,Xi'an People's Hospital,Xi'an 710004,China)
关键词:
白内障;  超声乳化白内障吸除术;  右美托咪定;  血流动力学;  应激反应;  炎性反应
Keywords:
Cataract;  Phacoemulsification;  Dexmedetomidine;  Hemodynamics;  Stress response;  Inflammatory reaction
分类号:
R 776.1
DOI:
DOI:10.3969/j.issn.1000-7377.2022.08.024
文献标志码:
A
摘要:
目的:探讨在白内障囊内摘除术(PHACO)中应用右美托咪定辅助麻醉对患者血流动力学和应激反应的影响。方法:选取行PHACO的白内障患者198例,按照随机数字表法随机分为两组,每组99例,对照组实施常规局部麻醉,观察组加用右美托咪定辅助麻醉,观察术后两组患者应激反应、炎性反应、血流动力学、眼内压和不良反应发生的情况。结果:观察组丙二醛(MDA)、过氧化脂质(LPO)水平为(32.71±7.14)nmol/L、(13.05±2.74)μoml/L,明显低于对照组的(35.28±7.85)nmol/L、(15.74±3.22)μoml/L,超氧化物歧化酶(SOD)水平为(27.32±3.25)μU/L则明显高于对照组的(23.81±4.13)μU/L(均P<0.05); 观察组血清肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平分别为(21.72±4.38)ng/L、(19.14±3.75)mg/L,明显低于对照组的(25.08±5.17)ng/L、(24.38±4.12)mg/L(均P<0.05); 观察组视网膜中央动脉、睫状后短动脉收缩期峰值流速(PSV)、舒张末期血流速度(EDV)分别为(9.07±1.26)cm/s、(2.61±0.49)cm/s、(12.73±1.85)cm/s、(4.58±0.62)cm/s明显高于对照组的(8.74±1.03)cm/s、(2.43±0.45)cm/s、(11.02±1.91)cm/s、(3.74±0.58)cm/s,而视网膜中央动脉、睫状后短动脉的阻力指数(RI)分别为(0.71±0.03)、(0.64±0.06)明显低于对照组的(0.72±0.04)、(0.66±0.07)(均P<0.05); 观察组不同时间的眼内压分别为(15.34±2.14)mmHg、(15.05±2.03)mmHg、(17.25±3.07)mmHg、(16.17±2.41)mmHg,对照组不同时间的眼内压分别为(15.52±2.07)mmHg、(15.02±2.05)mmHg、(19.51±3.13)mmHg、(17.18±2.62)mmHg,不同时间两组患者的眼内压比较有统计学差异(均P<0.05),与对照组比较,观察组眼内压较低(P<0.05),观察组与对照组眼内压变化趋势比较有统计学差异(P<0.05); 观察组不良反应发生率为2.02%,对照组未见不良反应发生,两组间比较无统计学差异(P>0.05)。结论:白内障患者PHACO手术时在局部麻醉的基础上联合应用右美托咪定可以有效减轻机体氧化应激反应和炎性反应,对稳定血流动力学和眼内压波动具有一定的临床意义,且不良反应发生率低。
Abstract:
Objective:To investigate the effect of dexmedetomidine assisted anesthesia on hemodynamics and stress response in patients undergoing phacoemulsification(PHACO).Methods:A total of 198 cataract patients undergoing PHACO were selected.According to the random number table method,they were randomly divided into two groups with 99 cases in each group.The control group received conventional local anesthesia,and the observation group received dexmedetomidine assisted anesthesia.Stress response,inflammatory response,hemodynamics,intraocular pressure and adverse reactions after operation in the two groups were observed.Results:The levels of malondialdehyde(MDA)and lipid peroxide(LPO)in the observation group were(32.71±7.14)nmol/L and(13.05±2.74)μmol/L,which were significantly lower than(35.28±7.85)nmol/L and(15.74±3.22)μmol/L in the control group,and the superoxide dismutase(SOD)level of(27.32±3.25)μU/L was significantly higher than(23.81±4.13)μU/L of the control group(all P<0.05).The serum levels of tumor necrosis factor-α(TNF-α)and sensitive C-reactive protein(hs-CRP)in the observation group were(21.72±4.38)ng/L and(19.14±3.75)mg/L respectively,which were significantly lower than(25.08±5.17)ng/L and(24.38±4.12)mg/L in the control group(all P<0.05).The peak systolic flow rate(PSV)and end diastolic flow rate(EDV)of central retinal artery and posterior short ciliary artery in the observation group were(9.07±1.26)cm/s,(2.61±0.49)cm/s,(12.73±1.85)cm/s and(4.58±0.62)cm/s respectively,which were significantly higher than(8.74±1.03)cm/s,(2.43±0.45)cm/s,(11.02±1.91)cm/s and(3.74±0.58)cm/s in the control group,the resistance index(RI)of central retinal artery and short posterior ciliary artery were(0.71±0.03)and(0.64±0.06),which were significantly lower than(0.72±0.04)and(0.66±0.07)in the control group(all P<0.05).The intraocular pressure of the observation group at different times was(15.34±2.14)mmHg,(15.05±2.03)mmHg,(17.25±3.07)mmHg and(16.17±2.41)mmHg,respectively.The intraocular pressure of the control group at different times was(15.52±2.07)mmHg,(15.02±2.05)mmHg,(19.51±3.13)mmHg and(17.18±2.62)mmHg,respectively.There were differences in intraocular pressure between the two groups at different times(all P<0.05).Compared with the control group,intraocular pressure in the observation group was lower(P<0.05),and there were differences in the change trend of intraocular pressure in the observation group and the control group(P<0.05).The incidence of adverse reactions was 2.02% in the observation group,and no adverse reactions occurred in the control group,and there was no significant difference between the two groups(P>0.05).Conclusion:Combined use of dexmedetomidine during PHACO on the basis of local anesthesia in cataract patients can effectively reduce oxidative stress response and inflammatory response,which has certain clinical significance in stabilizing hemodynamics and intraocular pressure fluctuation,and the incidence of adverse reactions is low.

参考文献/References:

[1] Lee CM,Afshari NA.The global state of cataract blindness[J].Curr Opin Ophthalmol,2017,28(1):98-103.
[2] Delbarre M,Froussart-Maille F.Signs,symptoms,and clinical forms of cataract in adults[J].J Fr Ophtalmol,2020,43(7):653-659.
[3] Yao K,Wang W.A summary of 70 years of cataract diagnosis and treatment in China[J].Zhonghua Yan Ke Za Zhi,2020,56(5):321-324.
[4] 崔健怡,胡水清.超声乳化吸出联合蓝光滤过型人工晶状体植入术对白内障患者视功能康复及生活质量的影响[J].陕西医学杂志,2019,48(2):244-247.
[5] 张伽雨,彭 娜,李 磊.超乳联合房角分离或小梁切除对PACG合并白内障患者血流动力学的影响[J].国际眼科杂志,2019,19(5):749-752.
[6] Lee S.Dexmedetomidine:Present and future directions[J].Korean J Anesthesiol,2019,72(4):323-330.
[7] 郝景宇.盐酸右美托咪定对老年白内障合并高血压手术患者的影响[J].国际眼科杂志,2017,17(7):1281-1284.
[8] 刘家琦,李凤鸣.实用眼科学[M].3版.北京:人民卫生出版社,2016:136-139.
[9] Meskini M,Arroub K,Bouabbadi S,et al.Cerulean cataract[J].J Fr Ophtalmol,2019,42(8):930-931.
[10] 秦文广,王 艳,杨 帅.除风益损汤联合西药治疗白内障术后虹膜睫状体炎随机平行对照研究[J].陕西中医,2018,39(7):925-927.
[11] Foster GJL,Ayers B,Fram N,et al.Phacoemulsification of posterior polar cataracts[J].J Cataract Refract Surg,2019,45(2):228-235.
[12] Boulter T,Bernhisel A,Mamalis C,et al.Phacoemulsification in review:Optimization of cataract removal in an in vitro setting[J].Surv Ophthalmol,2019,64(6):868-875.
[13] 林震琳,胡艳红.白内障超声乳化术后视觉质量的影响因素[J].国际眼科杂志,2017,17(12):2252-2255.
[14] Sharma N,Singhal D,Nair SP,et al.Corneal edema after phacoemulsification[J].Indian J Ophthalmol,2017,65(12):1381-1389.
[15] 訾聪娜,樊 娟,邢 珍,等.七氟烷联合右美托咪啶对眼科患儿全身麻醉苏醒期躁动的影响[J].国际眼科杂志,2019,19(11):1945-1949.
[16] 邓 旭,尧永华.右美托咪定在围术期氧化应激保护中的研究进展[J].实用医学杂志,2020,36(4):548-552.
[17] 李林佶.右旋美托咪定的临床研究新进展[J].西部医学,2020,32(2):308-312.
[18] 赵银莹,李军花,常平骏,等.白内障超声乳化术后球后血流动力学变化的研究[J].国际眼科杂志,2016,16(5):793-797.
[19] 胡 盼,胡宗莉,赵银洁,等.右美托咪定对表面麻醉下白内障手术患者血流动力学的影响[J].中华实验眼科杂志,2018,36(7):575-576.
[20] 段小莉.飞秒激光联合白内障超声乳化术治疗年龄相关性白内障[J].国际眼科杂志,2018,18(9):1635-1639.
[21] 李祥梅,石美琴,黄 颖.白内障超声乳化术后高眼压影响因素及护理研究进展[J].护士进修杂志,2018,33(9):791-794.

相似文献/References:

[1]崔健怡,胡水清.超声乳化吸出联合蓝光滤过型人工晶状体植入术对白内障患者 视功能康复及生活质量的影响[J].陕西医学杂志,2019,(2):244.
　CUI Jianyi,HU Shuiqing..Effect of phacoemulsification and blue light filtering intraocular lens implantation on visual function recovery and prognosis of sleep in cataract patients[J].,2019,(8):244.
[2]李海燕,马 波,柴 芳,等.前房注气术治疗白内障超声乳化术后角膜后弹力层脱离临床研究[J].陕西医学杂志,2019,(9):1182.
　LI Haiyan,MA Bo,CHAI Fang,et al.Clinical study of anterior air injection for descemet’s membrane detachment caused〖JZ〗by cataract phacoemulsification[J].,2019,(8):1182.
[3]郝兆芹,马 强△,武炳慧,等.高渗盐水对后发性白内障抑制作用的实验研究*[J].陕西医学杂志,2019,(11):1414.
　HAO Zhaoqin,MA Qiang,WU Binghui,et al.Experimental study of hypertonic saline’s effect on preventing posterior capsular opacification in rabbit eyes[J].,2019,(8):1414.
[4]郭建强,赵俊宏,张分队,等.优化脉冲技术在白内障合并睑板腺功能障碍患者围术期中的应用*[J].陕西医学杂志,2020,49(8):1003.[doi:DOI:10.3969/j.issn.1000-7377.2020.08.023]

备注/Memo

备注/Memo:
基金项目:国家自然科学基金资助项目(81801391)
更新日期/Last Update: 2022-08-04