应用自制麻醉针头经筋膜囊球后麻醉的临床效果观察  

Observation on the clinical efficacy of retrobulbar anesthesia with self-made anesthesia needle through tenon capsule

作　　者：黄海涛[1] 葛正威 肖霞 伍俊[1] 王会红 胡艳玲 陈忠平[2] Huang Haitao;Ge Zhengwei;Xiao Xia;Wu Jun;Wang Huihong;Hu Yanling;Chen Zhongping(Yongzhou AIER Eye Hospital,Yongzhou 425000,China;Changsha AIER Eye Hospital,Changsha 410000,China;Qiyang AIER Eye Hospital,Qiyang 426100,China)

机构地区：[1]永州爱尔眼科医院,永州425000 [2]长沙爱尔眼科医院,长沙410000 [3]祁阳爱尔眼科医院,祁阳426100

出　　处：《中华眼外伤职业眼病杂志》2023年第6期433-439,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：爱尔眼科医院集团科研基金项目(AF2101D15);永州市指导性科技计划项目(2021-YZKJZD-001)。

摘　　要：目的观察应用自制麻醉针头经眼球筋膜囊(tenon囊)行双路球后麻醉的临床效果。方法随机对照研究。选择永州爱尔眼科医院2021年9月至2022年8月行23 G玻璃体切除术球后麻醉者147例(147眼)为研究对象,均采用睫状神经节阻滞麻醉联合滑车神经阻滞麻醉(即双路球后麻醉)。将患者随机分为两组:利用常规5号细长针头经皮肤面麻醉方法为对照组,72例(72眼);利用专利针头经tenon囊麻醉方法为观察组,75例(75眼)。观察记录麻醉操作时间、麻醉起效时间、眼眶压评估、眼球制动测定、疼痛6节点评估、麻醉中不良反应及并发症、麻醉术后4 h后遗效应和患者满意度。结果观察组和对照组麻醉后间接眶压分别为(53.89±1.18)mmHg和(62.85±1.16)mmHg(1 mmHg=0.133 kPa),差异有统计学意义(P<0.01)。在麻醉中不良反应及并发症包括眼睑淤血(P=0.012)、追加麻醉(P=0.007)、一过性黑朦(P=0.042),差异均有统计学意义(均P<0.05)。两组在麻醉术后4 h后遗效应出现上睑下垂(P=0.006)、复视(P=0.001)、术眼疼痛(P=0.001)、患者自我满意度(P=0.005),术者满意度(P=0.043)等方面差异均具有统计学意义(均P<0.05)。观察组和对照组麻醉操作时间分别为(2.09±0.06)min和(2.06±0.06)min,差异无统计学意义(P>0.05),麻醉起效时间分别为(3.10±0.06)min和(3.18±0.07)min,差异无统计学意义(P>0.05)。两组在麻醉后2 min、4 min、6 min及术毕之间眼球制动效果评分差异均无统计学意义(均P>0.05)、两组疼痛程度在6节点之间评分差异均无统计学意义(均P>0.05)。结论应用自制麻醉针头经筋膜囊行双路球后麻醉相较常规球后麻醉患者眶压控制理想,麻醉风险及并发症少,患者及术者满意度高。Objective To investigate the clinical efficacy of doubletract retrobulbar anesthesia through tenon capsule with self-made anesthesia needle.Methods This was a randomized controlled study.A total of 147 eyes of 147 patients who underwent 23 G vitrectomy with retrobulbar anesthesia from Sep.2021 to Aug.2022,in Yongzhou AIER Eye Hospital were selected as the research subjects.The patients were randomly divided into two groups.Both groups were treated with ciliary ganglion block anesthesia combined with trochlear nerve block anesthesia,i.e.double tract retrobulbar anesthesia.The conventional group using five gauge slender needle was defined as the control group,with 72 eyes of 72 cases;and those with the tenon capsule anesthesia method applied using a patented needle was defined as the observation group,with 75 eyes of 75 cases.The operation time of anesthesia,onset time of anesthesia,evaluation of orbital pressure,measurement of eyeball immobilization,evaluation of pain at six points,adverse reactions and complications during anesthesia,after effects at four hours after anesthesia,and patient satisfaction were observed and recorded.Results The indirect orbital pressure after anesthesia in the observation group and the control group were(53.89±1.18)mmHg and(62.85±1.16)mmHg,with a significant difference(P<0.01).Advere reactions and complications during anesthesia included eyelid congestion(P=0.012),additional anesthesia(P=0.007),and amaurosis fugax(P=0.042).The differences were statistically significant(all P<0.05).There were significant differences in ptosis(P=0.006),diplopia(P=0.001),pain(P=0.001),patient satisfaction(P=0.005),and surgeon satisfaction(P=0.043)between the two groups(P<0.05).The operation anesthesia time for the observation group and the control group was(2.09±0.06)min and(2.06±0.06)min,and the difference was not statistically significant(P>0.05).The onset time of anesthesia was(3.10±0.06)min and(3.18±0.07)min,and the difference was not statistically significant(P>0.05).There were no significant

关 键 词：玻璃体切除术 TENON囊 麻醉 局部 

分 类 号：R614[医药卫生—麻醉学]