经巩膜激光睫状体光凝术治疗难治性青光眼的围术期管理  

Perioperative period management of transscleral cyclophotocoagulation in the treatment of refractory glaucoma

作　　者：张岩[1] 顾恩华[1] 

机构地区：[1]天津市眼科医院天津市眼科学与视觉科学重点实验室天津医科大学眼科临床学院,300020

出　　处：《中国实用眼科杂志》2015年第10期1150-1153,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨经巩膜二极管激光睫状体光凝术的围术期管理要点。方法回顾性分析2009年5月至2012年2月在天津市眼科医院经巩膜激光睫状体光凝术治疗的青光眼患者182例，术前行体格健康状况（ASA）分级与评估，术前全身及局部用药调控眼压。拟球后阻滞和全身麻醉。视觉模拟评分法对术前、术后疼痛评分。结果术前重要脏器功能评估：心电图显示异常30．8％，（56／182），高血压33．5％（61／182），肾功能异常7．1％（13／182），糖尿病20．1％（38／182），血钾低0．01％（2／182），肺心病2．7％（5／182），肥胖14．3％（26／182），高龄（年龄〉75岁）31．3％（57／182）。术后1天与1个月眼压与治疗前相比差异均有统计学意义（P=0．00，P=0．00）。行x2列表检验术前与术后1、24h疼痛，差异有统计学意义，（P=0．00，P=0．00）。结论经巩膜二极管激光睫状体光凝术是有效的治疗难治性青光眼的方法，患者全身合并症多，术前应进行全身状况评估与眼压调控。球后阻滞与全身麻醉并配合术后镇痛可保证围术期安全。Objective To discuss the proper preoperative period management of transseleral cyclo- photocoagulation in the treatment of refractory glaucoma. Methods Retrospectively analyzed the 182 eyes of 182 patients who accepted transscleral cyclophotocoagulation in Tianjin eye hospital from May 2009 to February 2012. ASA classification was used, local anesthesia combined with gen- eral anesthesia. Visual analogue scale was used to get the pain score before and after coagulation. Results Preoperative systemic functional assessment： 30.8% （56/182） had ECG abnormal, 33.5% （61/ 182） had hypertension, 7.1% （13/182） had abnormal renal function, 20.l% （38/182） had diabetes, others： low potassium 2 cases, pulmonary heart disease 5 cases, obesity 26 cases, 31.3% （57/182） were older than 75 years old. Postoperative 1 day, 1 month intraocular pressure difference compared with before treatment were statistically significant （F =1,43, P =0.00; F =2.24, P =0.00.） Pearson R＊C test, postoperative pain score within 1 hour and 24 hottrs had significantly difference compared with preoperative pain score （P =0.00, P =0.00）. Conclusions Transscleral cyclophotocoagulation is an effective treatment to refractory glaucoma, Patients have more systemic complications. Local anesthesia combined with general anesthesia is effective to control postoperative pain. Reasonable perioperative management is the effective guarantee for the safe operation.

关 键 词：经巩膜激光睫状体光凝术 难治性青光眼 围术期管理 

分 类 号：R775.05[医药卫生—眼科]