基础麻醉在配合度差的老年白内障患者超声乳化手术中的应用  

Clinical application of basal anesthesi for cooperation difficulty elderly cataract patients with phacoemulsification operation

作　　者：谢林碧 邵毅[2] 王敏 熊义斌 

机构地区：[1]高明区人民医院麻醉科及眼科,广东省佛山市528500 [2]南昌大学第一附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2015年第3期243-245,249,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81160118;81400372);全国临床医药专项基金(编号:L2012052);江西省青年科学基金(编号:20114BAB215036);江西省科技支撑计划项目(编号:20111BBG70026-2);江西省科技平台建设项目(编号:2013116);江西省卫计委科技计划项目(编号:20155154);江西省教育厅科技计划项目(编号:GJJ14170);南昌市指导性科技计划项目(编号:2013-210-48)~~

摘　　要：目的探讨表面麻醉联合基础麻醉下超声乳化术对配合度差(老年痴呆、智力低下、聋哑)的老年白内障患者的手术安全性,并观察术后并发症、最佳矫正视力、血液流变学及泪膜稳定性的变化情况。方法选取64例(87眼)老年痴呆、智力低下、聋哑老年白内障患者,随机分为A、B两组。A组在表面麻醉下行白内障超声乳化+人工晶状体植入术;B组采用表面麻醉复合基础麻醉下行白内障超声乳化+人工晶状体植入术。术前、术中及术后2周观察最佳矫正视力、术后并发症、血液流变学及泪膜稳定性情况。结果A组患者麻醉效果Ⅲ级22眼,B组患者Ⅲ级5眼,两组差异有统计学意义(χ2=0.000,P<0.05);两组术前最佳矫正视力、心率、舒张压和收缩压、泪膜破裂时间(break up time,BUT)、基础泪液分泌试验(Schirmer I test,SIT)差异均无统计学意义(均为P>0.05),术中两组患者心率、舒张压和收缩压相比差异均有统计学意义(t心率=9.158,t收缩压=8.552,t舒张压=7.259,均为P<0.05);术后2周两组患者最佳矫正视力相比差异有统计学意义(P<0.05),而BUT及SIT差异均无统计学意义(均为P>0.05)。B组手术时间(18.6±3.5)min明显比A组(26.8±7.2)min短,两组比较差异具有统计学意义(t=6.524,P<0.05);对比两组术后并发症,A组有12眼(27.27%),B组有5眼(11.63%),A组并发症发生率明显高于B组,两组差异具有统计学意义(χ2=4.268,P<0.05)。结论对配合度差的老年白内障患者(如老年痴呆、智力低下、聋哑)实施超声乳化手术时,选用表面麻醉联合基础麻醉能在术中获得更好的麻醉效果,提高患者的视觉质量,值得临床推广应用。Objective To observe the safety,postoperative complications,best corrected visual acuity,blood rheology and stability of tear film for uncooperation elderly cataract patients underwent phacoemulsification operation with surface and basal anesthesia. Methods Totally sixty-four senile dementia,mental retardation,deaf muteaged cataract patients（ 87eyes） were randomly divided into two groups： cataract phacoemulsification operation and IOL implantation with surface anesthesia（ group A）, cataract phacoemulsification surgery and IOL implantation with surface and basal anesthesia（ group B）. The postoperative complications,best corrected visual acuity,blood rheology and tear film function were observed at preoperatively,operatively and 2 week postoperatively. Results The number of eyes for anesthesia effect（ degree Ⅲ） were 27 eyes, including 22 eyes in group A,5 eyes in group B, there was statistically significance between group A and group B（ χ2 = 0. 000,P〈0. 05）; There was no significant difference in postoperative complications,best corrected visual acuity,blood rheology,Schirmer I test（ SIT） and break-up time（ BUT） between two groups preoperatively（ all P〉0. 05）. During the operation, there were statistically significance in blood rheology between two groups（ tHR = 9. 158,t SBp = 8. 552,t DBp = 7. 259, all P〉0. 05）; There was statistically significance in best corrected visual acuity between two groups（ P〈0. 05）,whereas no statistically significance in SIT and BUT（ all P〈0. 05）. The operative time of group A was（ 26. 8±7. 2） minutes and group B was（ 18. 6 ±3. 5） minutes,and group B was significantly shorter than group A（ t = 6. 524,P〈0. 05）; There were significant difference in complications between two groups（ χ2 = 4. 268,P〈0. 05）, including 12 eyes（ 27. 27%） in group A,5 eyes（ 11. 63%） in group B. Conclusion Phacoemulsification and IOL implantation with surface and basal anesthesia for uncooperation elderly cataract patients,wh

关 键 词：老年痴呆 智力低下 聋哑 白内障超声乳化手术 基础麻醉 

分 类 号：R136.9[医药卫生—劳动卫生]