肌肉松弛药对全身麻醉外斜视矫正手术患儿眼位的影响及相关性研究  

Study on the Effect and Correlation of Muscle Relaxants on the Eye Position of Children Undergoing Exotropia-Correcting Surgery under General Anesthesia

作　　者：明春平 吉伟 张晓宇 李淑婷 尹娟 MING Chunping;JI Wei;ZHANG Xiaoyu;LI Shuting;YIN Juan(Department of Ophthalmology,the People's Hospital of Cangzhou City,Cangzhou,Hebei 061000,China;Department of Anesthesiology,the People's Hospital of Cangzhou City,Cangzhou,Hebei 061000,China;Department of Operating Room,the People's Hospital of Cangzhou City,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市人民医院眼科,河北沧州061000 [2]沧州市人民医院麻醉科,河北沧州061000 [3]沧州市人民医院手术室,河北沧州061000

出　　处：《临床误诊误治》2025年第2期60-66,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2021年度医学科学研究课题(20210296)。

摘　　要：目的探讨肌肉松弛药对全身麻醉外斜视矫正手术患儿眼位的影响及相关性。方法选取2021年9月至2023年12月收治的外斜视患儿80例,均择期行全身麻醉外斜视矫正手术,按照随机数字表法分为观察组和对照组各40例。对照组予常规麻醉诱导,不使用肌肉松弛药,观察组在对照组基础上使用肌肉松弛药(注射用顺阿曲库铵)。比较2组麻醉诱导前(T0)、麻醉诱导后即刻(T1)、脑电双频指数(BIS)监测下浅麻醉期(T2)、BIS监测下深麻醉期(T3)时眼位评分,分析肌肉松弛药对患儿眼位变化的影响及BIS值与患儿眼位变化程度(眼位评分)的相关性;比较2组T0~T3时平均动脉压(MAP)、心率、苏醒质量、使用阿托品情况和不良反应,以及2组术前、术后3个月斜视度、融合范围、生存质量。结果观察组T1、T2、T3时眼位评分低于对照组(P<0.01);观察组全身麻醉过程中眼位升高比例低于对照组(P<0.05);使用肌肉松弛药患儿眼位升高风险较不使用肌肉松弛药患儿低(RR=5.000,95%CI:1.169,21.391);BIS值与全身麻醉外斜视矫正手术患儿眼位评分呈正相关(r=0.781,P<0.05);观察组T1、T2、T3时MAP、心率低于对照组(P<0.05);2组停药至自主呼吸恢复时间、苏醒时间、手术结束至出室时间比较差异无统计学意义(P>0.05);观察组使用阿托品比例低于对照组(P<0.05)。观察组呛咳、体动发生率分别为2.50%、5.00%低于对照组的20.00%、27.50%(P<0.05,P<0.01);观察组术后3个月斜视度低于对照组,融合范围、斜视儿童生存质量量表评分高于对照组(P<0.01)。结论全身麻醉外斜视矫正手术患儿麻醉诱导时使用肌肉松弛药可有效稳定血流动力学水平,减少阿托品的使用,降低眼位升高风险,保障手术疗效及麻醉安全性。Objective To investigate the effect and correlation of muscle relaxants on the eye position of children undergoing exotropia-correcting surgery under general anesthesia.Methods A total of 80 children with exotropia admitted from September 2021 to December 2023 were selected and underwent elective exotropia-correcting surgery under general anesthesia.They were divided into the observation group(n=40)and a control group(n=40)according to random number table method.The control group received conventional anesthesia induction without muscle relaxant,while the observation group received muscle relaxants(Benzylpenicillin for injection)on the basis of the control group.The eye position scores were compared between the two groups before anesthesia induction(T0),immediately after anesthesia induction(T1),during the shallow anesthesia period under bispectral index(BIS)monitoring(T2),and during the deep anesthesia period under BIS monitoring(T3).The correlation between muscle relaxants and the change in eye position of children,as well as the correlation between BIS values and the degree of change in eye position(eye position score)of children,were analyzed.The mean arterial pressure(MAP),heart rate(HR),quality of recovery,use of atropine,and adverse reactions at T0-T3,as well as strabismus degree,fusion range,and quality of life before surgery and at 3 month after surgery were compared between the two groups.Results The eye position scores at T1,T2,and T3 in the observation group were lower than those in the control group(P<0.01).The proportion of eye position elevated during general anesthesia in the observation group was lower than that in the control group(P<0.05).The risk of elevated eye position in children who used muscle relaxants was lower than that in children who did not use muscle relaxants(RR=5.000,95%CI:1.169,21.391).The BIS value was positively correlated with the eye position score of children undergoing exotropia-correcting surgery under general anesthesia(r=0.781,P<0.05).MAP and HR at T1,T2,and T3 in the o

关 键 词：外斜视 儿童 矫正手术 肌肉松弛药 全身麻醉 眼位 平均动脉压 苏醒质量 

分 类 号：R779.6[医药卫生—眼科]