静脉辅助镇静镇痛麻醉联合球后麻醉在玻璃体切除手术的有效性和安全性观察  

Observation of the effectiveness and safety of intravenously assisted sedative analgesic anesthesia combined with retrobulbar anesthesia in vitrectomy surgery

作　　者：崔婧婧 李芝婕 徐维蓉 陈菲[1] Cui Jingjing;Li Zhijie;Xu Weirong;Chen Fei(Department of Surgi-cal Anesthesiology,Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院手术麻醉科,200011

出　　处：《临床眼科杂志》2024年第4期333-337,共5页Journal of Clinical Ophthalmology

摘　　要：目的观察单纯球后麻醉与静脉辅助镇静镇痛麻醉联合球后麻醉在玻璃体切除手术中的有效性和安全性。方法前瞻性病例对照研究。在本院进行研究的对象为200名患者,手术治疗时间为2022年2月至2023年6月的玻璃体切除手术。通过随机分组的方式,将200名患者分为对照组和联合组。对照组接受单纯球后麻醉,而联合组则接受静脉辅助镇静镇痛麻醉联合球后麻醉。记录对照组和联合组的实验对象在不同时刻的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))以及镇静评分:入室后静卧10 min为T0、球后麻醉注射操作时为T_(1)、手术进行30 min为T_(2)、结束手术操作时为T_(3)。在T_(1)时点,我们记录了疼痛的发生率,并记录了两组患者在手术过程中出现的不良反应情况。此外,我们还记录了术前30 min和手术结束时的状态焦虑问卷评分(SAI),以及主刀医生和患者的满意度评分。结果在T_(1)、T_(2)和T_(3)时点,联合组的MAP和HR评分均明显低于对照组,同时镇静评分(Ramsay评分)明显高于对照组(均P<0.05)。在各个时点,联合组与对照组的SpO_(2)相比没有统计学意义上的差异。在T_(1)时点,联合组患者的疼痛发生率比对照组下降了39%;手术过程中,对照组和联合组均未出现恶心、呕吐、抑制呼吸等情况;术前30 min时,对照组和联合组的SAI评分差异无统计学意义(P=0.095),但联合组手术后的SAI评分明显低于对照组(P<0.001);手术医生和患者对联合组的满意度评分均高于对照组(P<0.001)。结论在进行玻璃体切除手术时,结合使用静脉辅助镇静镇痛麻醉和球后麻醉,可以更好地保持患者的血流动力学平稳,增加患者的满意度和舒适度,提高手术的安全性。Objective To observe the effectiveness and safety of pure peribulbar anesthesia versus combined intravenous sedation and analgesia with peribulbar anesthesia in vitrectomy surgery.Methods A prospective clinical study.This study included 200 patients who underwent elective vitrectomy surgery at our hospital between February 2022 and June 2023.The patients were randomly assigned into two groups:the control group(n=100)received peribulbar block anesthesia alone,while the combination group(n=100)received intravenous sedation and analgesia combined with peribulbar block anesthesia.Mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2)),and sedation scores were recorded at various time points:10 minutes of rest after admission(T0),during peribulbar block injection(T_(1)),30 minutes into the surgery(T_(2)),and at the end of surgery(T_(3)).Pain incidence at T_(1) and adverse reactions during the surgery were also noted.Additionally,state anxiety inventory(S-AI)scores were recorded 30 minutes before surgery and at the end of surgery,along with satisfaction scores from the primary surgeon and patients.Results At T_(1),T_(2),and T_(3),the combination group had significantly lower MAP and HR scores compared to the control group,while Ramsay sedation scores were significantly higher(all P<0.05).No statistically significant difference in SpO_(2) was observed between the groups at any time point.At T_(1),the pain incidence in the combination group was 39%lower than in the control group.No cases of nausea,vomiting,or respiratory depression occurred in either group during surgery.Preoperative S-AI scores 30 minutes before the surgery did not significantly differ between the groups(P=0.095).However,postoperative S-AI scores were significantly lower in the combination group(P<0.001).Both surgeon and patient satisfaction scores were significantly higher in the combination group(P<0.001).Conclusions Utilizing intravenous sedation and analgesia combined with peribulbar block anesthesia during vitrectomy surgery helps mai

关 键 词：单纯球后麻醉 静脉辅助镇静镇痛麻醉联合球后麻醉 玻璃体切除手术 

分 类 号：R779.6[医药卫生—眼科]