不同麻醉方式对外斜视儿童眼位改变的影响  

A Study of the Effect of Different Modes of Anaesthesia on the Change of Eye Position in Children with Exotropia

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

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

出　　处：《转化医学杂志》2024年第9期1528-1531,1541,共5页Translational Medicine Journal

基　　金：河北省卫生健康委医学科学研究课题计划(20210296)。

摘　　要：目的研究不同麻醉方式对外斜视儿童眼位的影响。方法随机纳入2021年6月至2023年6月沧州市人民医院治疗的外斜视患儿60例,分为氯胺酮静脉麻醉组、静吸复合麻醉组和局部麻醉组,每组20例,均予相应的麻醉方式。比较3组患儿手术前后知觉眼位变化情况;比较麻醉前、手术开始、牵拉眼球组织时以及术后拔管时/手术结束时3组患儿眼压情况;比较麻醉前及牵拉眼球组织时3组患儿生命体征[包括收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO_(2))、心率(HR)]变化;比较3组患儿眼心反射发生率以及手术时间。结果静吸复合麻醉组知觉眼位水平和垂直偏移程度变化均显著大于氯胺酮静脉麻醉组和局部麻醉组(P<0.05),氯胺酮静脉麻醉组知觉眼位水平和垂直偏移程度变化均显著大于局部麻醉组(P<0.05)。3组患儿的眼压在牵拉眼球组织时及术后拔管/结束时均有显著性差异。静吸复合麻醉组患儿眼压在牵拉眼球组织及术后拔管/结束时均显著低于氯胺酮静脉麻醉组和局部麻醉组(P<0.05),但术后拔管/结束时眼压较麻醉前显著增加(P<0.05)。氯胺酮静脉麻醉组和局部麻醉组在牵拉眼球组织及术后拔管/结束时的眼压显著高于麻醉前(P<0.05),但2组间比较无显著性差异无统计学意义(P>0.05)。牵拉眼球组织时,静吸复合麻醉组的HR、SpO_(2)、SBP及DBP的变化值均小于氯胺酮静脉麻醉组及局部麻醉组(P<0.05)。静吸复合麻醉组眼心反射发生率低于氯胺酮静脉麻醉组和局部麻醉组(P<0.05),手术时间显著短于氯胺酮静脉麻醉组和局部麻醉组(P<0.05)。结论静吸复合麻醉在外斜视手术中因其更好地改善眼位偏移、较少术中并发症以及更短的手术时间,可能是儿童外斜视手术中更优的选择。Objective To investigate the effects of different anesthesia methods on the ocular position of children with exotropia.Methods Sixty children with exotropia who were treated in Cangzhou People's Hospital from June 2021 to June 2023 were randomly enrolled and divided into three groups:ketamine intravenous anesthesia group,combined intravenous and inhalation anesthesia group,and local anesthesia group,with 20 cases in each group,and corresponding anesthesia methods were given respectively.The changes in perceptual eye position before and after surgery were compared among the three groups;the intraocular pressure of the three groups of children was compared before anesthesia,at the beginning of surgery,during traction of eye tissue,and at the end of extubation/postoperatively;the changes in vital signs[including systolic blood pressure(SBP),diastolic blood pressure(DBP),blood oxygen saturation(SpO_(2)),heart rate(HR)]of the three groups of children were compared before anesthesia and during traction of eye tissue;the incidence of oculocardiac reflex and surgical time were compared among the three groups.Results The changes in the horizontal and vertical deviation degrees of the perceptual eye position in the combined intravenous and inhalation anesthesia group were significantly greater than those in the ketamine intravenous anesthesia group and the local anesthesia group(P<0.05),and the changes in the horizontal and vertical deviation degrees of the perceptual eye position in the ketamine intravenous anesthesia group were significantly greater than those in the local anesthesia group(P<0.05).There were significant differences in the intraocular pressure of the three groups of children during traction of eye tissue and at the end of extubation/postoperatively.The intraocular pressure in the combined intravenous and inhalation anesthesia group was significantly lower than that in the ketamine intravenous anesthesia group and the local anesthesia group during traction of eye tissue and at the end of extubation/postope

关 键 词：麻醉方式 外斜视 眼位 肌肉松弛药 疗效比较研究 

分 类 号：R726.142.1[医药卫生—儿科] R726.142.4[医药卫生—临床医学]