右美托咪定与七氟醚对微血管减压术患者视神经鞘直径及术后恶心呕吐的影响：一项回顾性队列研究
Effects of dexmedetomidine and sevoflurane on optic nerve sheath diameter and postoperative nausea and vomiting in patients undergoing microvascular decompression: a retrospective cohort study.
作者信息
Sun Qi, Li Pengfei, Liu Chang, Gan Maoxiang, Mao Qingxiang, He Xuzhi, Xu Lunshan, Hu Yi
机构信息
Department of Anesthesiology, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China.
Department of Intensive Care Unit, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China.
出版信息
BMC Anesthesiol. 2025 Jun 9;25(1):293. doi: 10.1186/s12871-025-03147-2.
BACKGROUND
Observe the effects of dexmedetomidine(Dex) and sevoflurane(Sev) on the optic nerve sheath diameter(ONSD) in patients undergoing microvascular decompression (MVD). Find the most appropriate anesthetic maintenance medication scheme to reduce intracranial pressure (ICP)fluctuation and reduce the incidence of adverse reactions such as postoperative nausea and vomiting(PONV).
METHODS
In this retrospective cohort study, 90 patients undergoing elective MVD surgery were allocated into Groups P, D, and S. Maintenance of anaesthesia: Group P propofol(Propo) 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min); Group D Dex 0.4ug/(kg. h) + Propo 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min); Group S 1-2% Sev + Propo 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min). The changes in ultrasound-measured ONSD relative to baseline and the occurrence of PONV at different time periods under different anaesthetic maintenance regimens were compared.
RESULTS
(1) ONSD values increased significantly from T1 (10 min after tracheal intubation) to T6 (on leaving the post-anaesthesia care unit (PACU)), compared with the same group at T0 (5 min before anaesthesia). ONSD values at each time point of T1-T6, were the lowest in the Group D and the highest in the Group S.(2)In this study, the incidence of PONV within 24 h after MVD was 38.9%, with the lowest in Group D and the highest in Group S. (3) T2 (10 min after lying on side in forward neck flexion)ONSD, T6 (on leaving the PACU)ONSD, the usage of Sev and Dex were associated with PONV, whereas the usage of 0.4ug/(kg.h) Dex was a protective factor.
CONCLUSIONS
Dex has a lower effect on ONSD of MVD during the perioperative phase than Sev, and it can, to a certain extent, reduce the fluctuation of ICP. Dex lowers the incidence of PONV within 24 h after MVD and acts as a protective factor for PONV.
TRIAL REGISTRATION
The protocol of this study was registered at www.chictr.org.cn (07/02/2024,ChiCTR MR-50-24-010856).
背景
观察右美托咪定（Dex）和七氟醚（Sev）对微血管减压术（MVD）患者视神经鞘直径（ONSD）的影响。寻找最合适的麻醉维持用药方案，以减少颅内压（ICP）波动，并降低术后恶心呕吐（PONV）等不良反应的发生率。
方法
在这项回顾性队列研究中，90例行择期MVD手术的患者被分为P组、D组和S组。麻醉维持：P组丙泊酚（Propo）4 - 12mg/（kg·h）+瑞芬太尼0.1 - 0.2μg/（kg·min）；D组Dex 0.4μg/（kg·h）+ Propo 4 - 12mg/（kg·h）+瑞芬太尼0.1 - 0.2μg/（kg·min）；S组1 - 2% Sev + Propo 4 - 12mg/（kg·h）+瑞芬太尼0.1 - 0.2μg/（kg·min）。比较不同麻醉维持方案下超声测量的ONSD相对于基线的变化以及不同时间段PONV的发生情况。
结果
（1）与T0（麻醉前5分钟）时同一组相比，从T1（气管插管后10分钟）至T6（离开麻醉后监护病房（PACU）时），ONSD值显著增加。T1 - T6各时间点的ONSD值，D组最低，S组最高。（2）本研究中，MVD术后24小时内PONV的发生率为38.9%，D组最低，S组最高。（3）T2（前屈颈部侧卧后10分钟）时的ONSD、T6（离开PACU时）的ONSD、Sev和Dex的使用与PONV相关，而0.4μg/（kg·h）Dex的使用是一个保护因素。
结论
围手术期Dex对MVD患者ONSD的影响低于Sev，且能在一定程度上降低ICP波动。Dex降低了MVD术后24小时内PONV的发生率，并对PONV起到保护作用。
试验注册
本研究方案已在www.chictr.org.cn注册（2024年2月7日，ChiCTR MR - 50 - 24 - 010856）。
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