肌注阿托品对斜视手术中眼心反射的影响  

Effect of Intramuscular Atropine Injection on Oculocardiac Reflex in Strabismus Surgery

作　　者：胡慧丽[1] 陈嘉宝 杨雅童 李金瑛[1] HU Hui-li;CHEN Jia-bao;YANG Ya-tong;LI Jin-ying(Department of Ophthalmology,Peking University Shenzhen Hospital,Shenzhen 518035,Guangdong Province,China)

机构地区：[1]北京大学深圳医院眼科,广东深圳518035

出　　处：《罕少疾病杂志》2021年第2期8-9,共2页Journal of Rare and Uncommon Diseases

摘　　要：目的观察术前肌注阿托品注射液对局部麻醉下斜视术中眼心反射(OCR)发生率的影响。方法选取2018年至2019年在我院就诊并行局麻手术治疗的水平斜视患者50例50眼,外斜视患者进行外直肌后徙联合内直肌缩短术,对内斜视患者进行内直肌后徙联合外直肌缩短术。随机分为A组(术前不肌注硫酸阿托品注射液)和B组(术前30min肌注硫酸阿托品注射液,成人剂量为0.5mg),记录所有患者手术开始时、勾肌肉、缝肌肉、剪断肌肉、缝于巩膜壁等步骤心率,眼心反射的阳性标准:以心率变化幅度超过或等于基础心率的10%为阳性。对比两组在斜视术中眼心反射发生的情况,比较操作不同眼外肌时眼心反射发生情况。结果B组眼心反射发生率(45%)比A组术中眼心反射发生率(80%)低(P<0.05)。A组内直肌诱发OCR发生率(90%)高于B组内直肌诱发的OCR发生率(60%),P<0.05;A组外直肌诱发的OCR发生率(70%)高于B组外直肌诱发的OCR发生率(30%),P<0.05;两组内直肌诱发OCR发生率均高于同组外直肌诱发的OCR发生率,P<0.05。结论局麻斜视手术前肌注硫酸阿托品注射液可降低术中OCR的发生率,术中操作内直肌时比外直肌OCR发生率更高。Objective To observe the effect of preoperative intramuscular injection of atropine on the incidence of oculocardiac reflex(OCR)in strabismus surgery treated with local anesthesia.Methods 50 patients(50 eyes)who were diagnosed with horizontal strabismus and treated with local anesthesia in our hospital from 2018 to 2019 were selected.The patients diagnosed with exotropia were undergore lateral rectus recession and medial rectus shortening,while the patients diagnosed with esotropia were underwent medial rectus recession and lateral rectus shortening.All patients were randomly divided into group A(without preoperative atropine injection)and group B(30 min preoperative intramuscular injection of atropine with an adult dose of 0.5 mg).The heart rate of all patients was recorded at the beginning of the operation and the step of hooking muscle,suturing muscle,cutting muscle,and suturing muscle on the scleral wall,etc.The positive standard of OCR was defined as that the heart rate was more than or equal to 10%of the base heart rate.The incidence of OCR during strabismus surgery was compared between the two groups,and the occurrence of OCR in different operations of extraocular muscles was compared.Results The incidence of OCR in group B(45%)was lower than that in group A(80%)(P<0.05).The incidence of OCR induced by medial rectus in group A(90%)was higher than that in group B(60%)(P<0.05).The incidence of OCR induced by lateral rectus in group A(70%)was higher than that in group B(30%)(P<0.05).The incidence of OCR induced by medial rectus muscle was higher than that induced by lateral rectus in each group(P<0.05).Conclusion Atropine injection before strabismus surgery treated with local anesthesia can reduce the incidence of OCR and the OCR induced by medial rectus muscle was higher than that induced by lateral rectus.

关 键 词：斜视手术 眼心反射 阿托品注射液 

分 类 号：R777.41[医药卫生—眼科]