不同剂量透明质酸酶在眼球周麻醉中降低眼内压临床疗效  

Effect of Addition different dosage hyaluronidase to peribulbar anesthesia mixture for lowering intraocular pressure

作　　者：帖红艳[1] 汪晓凯[2] 雷方[3] 陈彬川[1] 张鑫[1] 

机构地区：[1]郑州大学第二附属医院眼科,河南郑州450014 [2]郑州大学护理学院,河南郑州450052 [3]河南科技大学,河南洛阳471003

出　　处：《中国实用眼科杂志》2014年第11期1317-1320,共4页Chinese Journal of Practical Ophthalmology

基　　金：河南省2011年科技发展计划（112102310568）

摘　　要：目的 观察和比较在眼球周麻醉中加用不同剂量的透明质酸酶对眼压的影响,探讨透明质酸酶在眼球周麻醉中的合适用量.方法 临床病例对照研究.对2010年3～10月在郑州大学第二附属医院眼科收集眼科行内眼手术患者120例（120只眼）,分为4组,每组30例（30只眼）.组1球周注射利多卡因和布比卡因注射液等比混合液3ml;组2、组3、组4球周注射利多卡因和布比卡因注射液等比混合液3ml分别加透明质酸酶针75 U;150 U,300 U;麻醉前、后测量眼压及做角膜内皮镜和视网膜电流图检查.结果 组1麻醉后较麻醉前眼压升高,差异有统计学意义[（15.64±1.71） versus（18.09± 2.95） mmHg,P＜0.05].组2、组3、组4麻醉后眼压均较麻醉前降低差异有统计学意义（16.20±1.71） versus （14.97±1.00） mmHg,P＜0.05; （16.32±1.69） versus （14.66±1.51） mmHg,P＜0.05; （16.52±1.76） versus （14.63±2.03） mmHg,P＜0.05.麻醉后组2、组3、组4之间眼压比较差异均无统计学意义（14.79±1.00） versus （14.66±1.51） versus （14.63±2.03） mmHg;P＞0.05.麻醉前后角膜内皮镜及视网膜电流图检查均差异无统计学意义（P＞0.05）.结论 球周麻醉中应用透明质酸酶,可以降低眼内压,并且对眼局部无毒副反应.但其降低眼压的效果并不随着透明质酸酶用量的增加而增强.Objective To observe the effectiveness of addition different dosage hyaluronidase to peribulbar anesthesia mixture for lowering intraocular pressure and find the right dosage of hyaluronidase in peribulbar anesthesia.Methods A case-control prospectively study.The clinical data from 120 cases （120 eyes） undergone intraocular surgery were analyzed.The cases were divided into 4 groups randomly and there were 30 cases （30 eyes） every group.Group 1 was peribulbar anesthesia with 3ml mixed liquor of lidocaine and bupivacaine.Group 2,Group 3 and Group 4 were peribulbar anesthesia with 3ml mixed liquor of lidocaine and bupivacaine which addition hyaluronidase 75u,150u,300u,respectively.The intraocular pressure was observed,the corneal endothelial cells were counted,and electroretinogram before and after perform peribulbar anesthesia were examined.Results The intraocular pressure were increased post-peribulbar anesthesia than pre-peribulbar anesthesia in group 1 （15.64±1.71 versus 18.09±2.95mmHg,P ＜0.05）.It had significant differences change between group 1 post-peribulbar anesthesia and pre-peribulbar anesthesia.The intraocular pressure were decreased post-peribulbar anesthesia than pre-peribulbar anesthesia in group 2,group 3 and group 4.（16.20±1.71 versus 14.97±1.00 mmHg,P ＜0.05; 16.32±1.69 versus 14.66±1.51 rnmHg,P ＜ 0.05; 16.52±1.76 versus 14.63±2.03mmHg,P ＜0.05）,the changes had significant differences.No significant differences were found in intraocular pressure value among group 2,group 3 and group 4 post-peribulbar anesthesia （14.79±1.00 versus 14.66±1.51 versus 14.63±2.03mmHg; P ＞0.05）.The changes of electroretinogram and counting of the corneal endothelial cells had no significantly different （P ＞0.05）.Conclusions Hyaluronidase can effectively decrease intraocular pressure after peribulbar anesthesia.No severe adverse effect is found after addition hyaluronidase in peribulbar anesthesia.But its effects dose not increase with increasing of the dosage.

关 键 词：透明质酸酶 剂量 球周麻醉 眼压 

分 类 号：R737.9[医药卫生—肿瘤]