CAJ | 학술논문

目的观察比较两种不同入路球后麻醉在微创玻璃体切割手术的应用效果.方法临床病例对照研究,纳入行23 G(23-gauge)联合25 G经结膜无缝合玻璃体手术的患者120例并随机分为A、B两组,A组应用颞侧一针麻醉法,B组应用传统球后神经阻滞进行注射麻醉,从疼痛、制动、并发症、生命体征的变化、主刀及病人满意度等方面对两种方法进行比较研究.结果 A、B两组间疼痛评分(F =319.1,P＜0.05)、制动评分(F =1267.9,P＜0.05),差异有统计学意义.麻醉过程中两组的疼痛评分存在差异(t =-6.4,P＜0.05),A组(3.3±1.9)＜B组(5.5±2.0)；制动评分在2 min时A组(7.1±2.2)＜B组(9.1±2.0),(t =-5.2,P＜0.05)、4 min时A组(3.8±2.0)＜B组(5.3±2.1),(t =-3.9,P＜0.05),差异有统计学意义.麻醉注射时血压A组(15.1±0.8) kPa ＜B组(15.3±1.2) kPa,差异有统计学意义(t =-4.7,P＜0.05)；脉搏A组(109±7)次/min＜B组(123±9)次/min,差异有统计学意义(t =-5.3,P＜0.05).A组达制动要求时间短(t=-3.1,P＜0.05).主刀(F =0.03,P ＜0.05)和患者(F =0.01,P＜0.05)的满意度差异有统计学意义.A组口鼻麻木感2例,B组暂时性黑朦1例,10 min后需要补充麻药:A组2例、B组7例,术中需补充麻药B组有6例；术中及术后均未发生麻醉相关的并发症.结论颞侧一针麻醉法用于微创玻璃体切割手术有良好效果,与传统球后麻醉相比,方法简单、注射次数少、主刀和患者满意度高,值得进一步研究.
목적 관찰비교량충불동입로구후마취재미창파리체절할수술적응용효과.방법 림상병례대조연구,납입행23 G(23-gauge)연합25 G경결막무봉합파리체수술적환자120례병수궤분위A、B량조,A조응용섭측일침마취법,B조응용전통구후신경조체진행주사마취,종동통、제동、병발증、생명체정적변화、주도급병인만의도등방면대량충방법진행비교연구.결과 A、B량조간동통평분(F =319.1,P＜0.05)、제동평분(F =1267.9,P＜0.05),차이유통계학의의.마취과정중량조적동통평분존재차이(t =-6.4,P＜0.05),A조(3.3±1.9)＜B조(5.5±2.0)；제동평분재2 min시A조(7.1±2.2)＜B조(9.1±2.0),(t =-5.2,P＜0.05)、4 min시A조(3.8±2.0)＜B조(5.3±2.1),(t =-3.9,P＜0.05),차이유통계학의의.마취주사시혈압A조(15.1±0.8) kPa ＜B조(15.3±1.2) kPa,차이유통계학의의(t =-4.7,P＜0.05)；맥박A조(109±7)차/min＜B조(123±9)차/min,차이유통계학의의(t =-5.3,P＜0.05).A조체제동요구시간단(t=-3.1,P＜0.05).주도(F =0.03,P ＜0.05)화환자(F =0.01,P＜0.05)적만의도차이유통계학의의.A조구비마목감2례,B조잠시성흑몽1례,10 min후수요보충마약:A조2례、B조7례,술중수보충마약B조유6례；술중급술후균미발생마취상관적병발증.결론 섭측일침마취법용우미창파리체절할수술유량호효과,여전통구후마취상비,방법간단、주사차수소、주도화환자만의도고,치득진일보연구.
Objective To evaluate the efficacy of micro-invasive vitrectomy with two retrobulbar anesthetic methods.Methods Clinical case-control study,120 patients scheduled for 3-port pars plana vitrectomy using 23-gauge instrumentation combined with 25-gauge infusion were randomly divided into two groups according to anesthetic method.Patients in group A were anesthetized with an injection of narcotic through temporal side; patients in group B received the traditional retrobulbar nerve block.Main outcome measures included Visual analogue scale,immobilization score,complications,vital signs observation,the surgeon and patient satisfaction etc.Results The differences of Visual analogue scale (F =319.1,P ＜0.05) and immobilization score (F =1267.9,P ＜0.05) between group A and group B were statistically significant.Visual analogue scale of group A and group B was different during anaesthetizing (t =-6.4,P ＜0.05) and group A (3.3±1.9) ＜group B (5.5±2.0).The differences of immobilization score at 2 minutes (t =-5.2,P ＜0.05) and 4 minutes (t =-3.9,P ＜0.05) were statistically significant,and group A (7.1±2.2) ＜group B (9.1±2.0) at 2 minutes; group A (3.8±2.0) ＜group B (5.3±2.1) at 4 minutes respectively.The differences of blood pressure between group A and group B were statistically significant (t =-4.7,P ＜0.05) with group A (15.1±0.8) ＜group B (15.3±1.2); respiratory rate in group A (109±7) was lower than that in group B (123±9)with statistical significance (t =-5.3,P ＜0.05).The time of reaching immobilization criterion was shorter (t =-3.1,P ＜0.05) in group A.The differences of the satisfactory degree of surgeon (F =0.03,P ＜0.05) and patient (F =0.01,P ＜0.05) between group A and group B were statistically significant.Oronasal numbness was found in 2 patients from group A,and temporary blackouts was found in 1 patient from group B.Two patients in group A and 7 patients in group B required additional anesthesia ten minutes after the first narcotic,and 6 patients in group B required that during surgery time.No anesthesia-related complications occurred in this study.Conclusions Anesthesia via temporal side for micro-invasive vitrectomy shows good clinical results.It is easier,requires lesser times of injection,gains higher satisfactory degree of surgeon and patient compared with traditional retrobulbar nerve block.Further studies are needed to explore its functions.