球筋膜下麻醉在高眼壓下復(fù)合式小梁切除術(shù)中的應(yīng)用

王　麗，王曉霞，林　娜

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球筋膜下麻醉在高眼壓下復(fù)合式小梁切除術(shù)中的應(yīng)用

王麗，王曉霞，林娜

Department of Ophthalmology, First People’s Hospital of Luoyang, Luoyang 471000, Henan Province, China.

?METHODS:Forty-six eyes(46 cases) of primary glaucoma received compound trabeculectomy under Sub-tenon’s anesthesia, whose preoperative intraocular pressure were higher than normal after 24 to 48h of combined medication. Both efficacy and complication of the anesthesia were studied.

?RESULTS: One minute after anesthetic injection, all cases were able to achieve the effect of analgesia and eye brake. During the operation, 0 level of anesthesia effect included 35 eyes(76%), 1 level of anesthesia effect included 10 eyes(22%), 2 level of anesthesia effect included 1 eye(2%). Only 1 case of these patients needed to add the surface anesthetic once, and other cases were successfully operatedunder Sub-tenon’s anesthesia. The total effective rate was 98%. No anesthesia complications occurred in all cases.

?CONCLUSION:Sub-Tenon’s anesthesia is safe, effective, simple and quick for compound trabeculectomy with high intraocular pressure.

目的：評(píng)估球筋膜下麻醉在高眼壓下復(fù)合式小梁切除術(shù)中的有效性與安全性。

方法：選取2014-02/2015-06在我科住院后聯(lián)合用藥24～48h眼壓控制不良的原發(fā)性青光眼患者46例46眼，于球筋膜麻醉下行復(fù)合式小梁切除術(shù)，觀察麻醉效果及并發(fā)癥。

結(jié)果：所有患者注射麻藥后1min均能達(dá)到鎮(zhèn)痛、眼球制動(dòng)效果。手術(shù)過(guò)程中，0級(jí)麻醉效果35眼(76%)，1級(jí)麻醉效果10眼(22%)，2級(jí)麻醉效果1眼(2%)。除1例1眼患者術(shù)中需追加1次表麻劑后完成手術(shù)，其余患者均能在球筋膜麻醉下配合手術(shù)，麻醉總有效率為98%。術(shù)中術(shù)后無(wú)1例出現(xiàn)麻醉相關(guān)并發(fā)癥。

結(jié)論：高眼壓下復(fù)合式小梁切除術(shù)中應(yīng)用球筋膜下麻醉安全有效、簡(jiǎn)便快捷。

球筋膜下麻醉；復(fù)合式小梁切除術(shù)；高眼壓；青光眼

引用：王麗，王曉霞，林娜.球筋膜下麻醉在高眼壓下復(fù)合式小梁切除術(shù)中的應(yīng)用.國(guó)際眼科雜志2016;16(11):2139-2141

0　引言

臨床上部分青光眼患者聯(lián)合用藥后眼壓仍控制不良，需及時(shí)行復(fù)合式小梁切除術(shù)以有效控制眼壓、保護(hù)視功能[1]，而良好的麻醉是手術(shù)成功的前提。球后麻醉、球周麻醉雖然麻醉效果確切，但是其眼部及全身的嚴(yán)重并發(fā)癥限制了其臨床應(yīng)用。而表面麻醉、球結(jié)膜下麻醉較為表淺、麻醉不持久，術(shù)中需多次追加麻醉藥物，甚至需改變麻醉方式，延長(zhǎng)了手術(shù)時(shí)間、增加了手術(shù)風(fēng)險(xiǎn)。我們對(duì)我院眼科2014-02/2015-06收住的聯(lián)合用藥眼壓控制不良的原發(fā)性青光眼患者在球筋膜麻醉下行復(fù)合式小梁切除術(shù)，效果良好，現(xiàn)報(bào)告如下。……