初次与再次斜视矫正手术中眼迷走神经反射发生率及严重性的临床研究  

Incidence and severity of vagus nerve reflex during primary and secondary strabismus surgery

作　　者：袁菁[1] 汪锐[1] 胡维琨 Yuan Jing;Wang Rui;Hu Weikun(Department of Ophthalmology,Wuhan Sixth Hospital Affiliated Hospital of Jianghan University,Wu han 430015,China)

机构地区：[1]武汉市第六医院江汉大学附属医院眼科

出　　处：《临床眼科杂志》2019年第6期549-551,共3页Journal of Clinical Ophthalmology

基　　金：武汉市卫生和计划生育委员会科学基金资助项目(WX17Q01)

摘　　要：目的探讨初次与再次老年斜视矫正手术中眼迷走神经反射发生率以及后果,分析引起眼迷走神经反射的原因,予以预防。方法选取老年斜视患者81例,其中初次手术42例作为Ⅰ组,再次手术39例作为Ⅱ组,对两组患者眼迷走神经反射发生率以及后果进行统计,分析两组患者引起眼迷走神经反射的原因。结果Ⅰ组眼迷走神经反射发生率为38. 10%,发生频率为(1. 88±0. 11)次/例,Ⅱ组分别为89. 74%和(3. 46±0. 20)次/例,Ⅰ组患者因眼迷走神经反射发生而停止手术(1. 25±0. 13)次/例,心率下降(12. 38±1. 05)次/min,术后恶心发生率为30. 95%,Ⅱ组分别为(3. 10±0. 22)次/例、(18. 97±1. 13)次/min和58. 97%,上述数据Ⅰ组均明显低于Ⅱ组,两组比较有统计学意义(P <0. 05)。引起Ⅰ组患者眼迷走神经反射的原因以牵拉肌肉为主,占83. 33%,而Ⅱ组患者以探查、组织分离以及暴露术野为主,分别占26. 45%、28. 10%、22. 31%。两组比较差异有统计学意义(P <0. 05)。结论与初次手术相比,再次接受斜视矫正手术的患者更容易在术中出现眼迷走神经反射,且因眼迷走神经反射而停止手术、心率下降以及术后恶心呕吐者也明显多于初次手术患者。在术前应与患者进行充分沟通,手术中轻柔操作,需要时可以使用阿托品缓解症状。Objective To investigate the incidence and clinical outcome of vagus nerve reflex during primary and secondary strabismus surgery,and to analyze the cause of vagus nerve reflex for prevention of onset. Methods A total of81 elderly patients with strabismus,including 42 cases who underwent primary surgery as group Ⅰ and 39 cases who underwent secondary surgery as group Ⅱ,were included. Incidence of vagus nerve reflex during the surgery,surgical outcomes,as well as causes for the vagus nerve reflex were assessed. Results Incidence and frequency of vagus nerve reflex in group Ⅰ and Ⅱ was 38. 10%,1. 88 ± 0. 11 times per case,and 89. 74%,3. 46 ± 0. 20 times per case,respectively. In group Ⅰ,the frequency of operation cessation due to vagus nerve reflex was 1. 25 ± 0. 13 times per cases,heart rate decreased by12. 38 ± 1. 05 beats/min,and the incidence of postoperative nausea was 30. 95%. In group Ⅱ,the corresponding numbers were 3. 10 ± 0. 22 times per case,18. 97 ± 1. 13 times/min and 58. 97%,respectively. The above parameters in group Ⅱ were all significantly higher than group Ⅰ( P < 0. 05). The cause of vagus nerve reflex was mainly muscle retraction in group Ⅰ( 83. 33%),and included exploration( 26. 45%),tissue isolation( 28. 10%) and exposure of the operative field( 22. 31%) in group Ⅱ. The inter-group difference was statistically significant( P < 0. 05). Conclusion Compared with primary strabismus surgery,patients who underwent secondary surgery were more prone to intraoperative vagus nerve reflex. The risk of operation cessation,heart rate decline,postoperative nausea and vomiting was also significantly higher during secondary surgery. Patients with strabismus should be fully informed before the surgery,surgical operations should be cautious,and atropine could be used if needed to relieve symptoms.

关 键 词：老年 斜视矫正术 眼迷走神经反射 眼心反射 

分 类 号：R47[医药卫生—护理学]