低剂量卡巴胆碱在有晶状体眼后房型人工晶状体植入术中应用的有效性和安全性  

Effectiveness and safety evaluation of low-dose carbachol application during implantable implantation for myopic eyes

作　　者：胡盼[1] 黄菊[1] 赵银洁[2] 陈春林[1] 叶剑[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所眼科,重庆400042 [2]第三军医大学大坪医院野战外科研究所麻醉科,重庆400042

出　　处：《中华实验眼科杂志》2017年第3期255-258,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 质量分数0.01%卡巴胆碱注射液是M胆碱受体和神经节及骨骼肌N胆碱受体激动剂，在眼科用于白内障和晶状体手术中缩小瞳孔和开放周边虹膜切开口，增加房水引流，但其经前房注射后容易引起全身和局部胆碱样反应，而低质量浓度卡巴胆碱前房注射后是否具有较好的效果及较低的胆碱样反应的发生率尚不清楚。目的 比较0.01%卡巴胆碱与0.005%卡巴胆碱注射液在有晶状体眼后房型人工晶状体（ICL）植入术中前房注射后的疗效及安全性。方法 纳入2014年9月至2015年9月在第三军医大学大坪医院拟行ICL植入术的患者76例152眼，患者双眼均接受ICL植入术及激光虹膜周边切开术，手术间隔时间为1 d，术中右眼均用0.01%卡巴胆碱原液行前房注射以缩小瞳孔，左眼均用0.005%卡巴胆碱稀释液行前房注射。检测指标为手术持续时间、术后2 h眼压及术后24 h内全身胆碱样反应的发生率。结果 0.01%卡巴胆碱原液组和0.005%卡巴胆碱稀释液组手术持续时间分别为（11.86±2.39）min和（11.22±1.85）min，组间比较差异无统计学意义（t＝1.851，P＝0.066）。0.01%卡巴胆碱原液组手术前后的眼压值分别为（15.76±2.18）mmHg（1 mmHg＝0.133 kPa）和（13.58±2.24）mmHg，而0.005%卡巴胆碱稀释液组分别为（15.70±2.35）mmHg和（13.12±2.17）mmHg，2个浓度卡巴胆碱对眼压值的影响差异无统计学意义（F分组＝0.986，P＝0.322）；术后2 h眼压值低于术前，差异有统计学意义（F时间＝97.339，P＝0.000）；不同时间与药物浓度之间无交互作用（F交互作用＝0.772，P＝0.381）。0.005%卡巴胆碱稀释液组患者头晕、恶心、呕吐的发生率均明显低于0.01%卡巴胆碱原液组，差异均有统计学意义（χ2＝13.01、5.16、4.03，均P〈0.05）。结论 0.005%卡巴胆碱稀释液能有效发挥缩瞳作用和保证手术时间，同时可降低患者全身胆碱样反应Background Carbachol solution （0.01%） is an agonist of M cholinoceptor and skeletal muscle N cholinoceptor, and it is used to play miotic effect and open peripheral iridectomic hole during the surgery of implantable collamer lens （ICL） implantation in order to lower intraocular pressure （IOP）. However, the anterior chamber injection of 0.01% carbachol solution often causes relevant complications, while whether lower dose of carbachol solution is effective and safe is unclear.Objective This study was to compare the effectiveness and safety between 0.01% carbachol solution and 0.005% carbachol solution after anterior chamber injection during the ICL implantation.Methods One hundred and fifty-two eyes of 76 cataract patients were included in Daping Hospital of Third Military Medical University from September 2014 to September 2015.ICL implantation and periphery iridectomy were carried out on both eyes of the patients and the 0.01% carbachol solution was injected into the anterior chamber during the surgery of the right eyes and 0.01% carbachol solution was used in the left eyes.The operation duration and IOP at postoperative 2 hours and systemic choline-like reaction were compared between 0.01% carbachol solution group and 0.005% carbachol solution group.Results The mean operation duration was （11.86±2.39） minutes and （11.22±1.85） minutes in the 0.01% carbachol group and 0.005% carbachol group, without significant difference between two groups （t=1.851, P=0.066）. IOP was （15.76±2.18）mmHg and （13.58±2.24）mmHg in the 0.01% carbachol group before and after surgery, and those in the 0.005% carbachol group was （15.70±2.35）mmHg and （13.12±2.17）mmHg, there was no significant difference in the IOP between the two concentrations of carbachol （Fgroup=0.986, P=0.322）. The IOP at postoperative 2 hours was lower than that before operation, the difference was statistically significant（Ftime=97.339, P=0.000）. There was no interaction between drug concentration and time （Fcorr

关 键 词：卡巴胆碱 人工晶状体 有晶状体眼人工晶状体 胆碱样反应 近视/治疗 前房注射 人 

分 类 号：R779.6[医药卫生—眼科]