CAJ | 학술논문

目的观察和比较在眼球周麻醉中加用不同剂量的透明质酸酶对眼压的影响,探讨透明质酸酶在眼球周麻醉中的合适用量.方法临床病例对照研究.对2010年3～10月在郑州大学第二附属医院眼科收集眼科行内眼手术患者120例(120只眼),分为4组,每组30例(30只眼).组1球周注射利多卡因和布比卡因注射液等比混合液3ml;组2、组3、组4球周注射利多卡因和布比卡因注射液等比混合液3ml分别加透明质酸酶针75 U;150 U,300 U;麻醉前、后测量眼压及做角膜内皮镜和视网膜电流图检查.结果组1麻醉后较麻醉前眼压升高,差异有统计学意义[(15.64±1.71) versus(18.09± 2.95) mmHg,P＜0.05].组2、组3、组4麻醉后眼压均较麻醉前降低差异有统计学意义(16.20±1.71) versus (14.97±1.00) mmHg,P＜0.05; (16.32±1.69) versus (14.66±1.51) mmHg,P＜0.05; (16.52±1.76) versus (14.63±2.03) mmHg,P＜0.05.麻醉后组2、组3、组4之间眼压比较差异均无统计学意义(14.79±1.00) versus (14.66±1.51) versus (14.63±2.03) mmHg;P＞0.05.麻醉前后角膜内皮镜及视网膜电流图检查均差异无统计学意义(P＞0.05).结论球周麻醉中应用透明质酸酶,可以降低眼内压,并且对眼局部无毒副反应.但其降低眼压的效果并不随着透明质酸酶用量的增加而增强.
목적 관찰화비교재안구주마취중가용불동제량적투명질산매대안압적영향,탐토투명질산매재안구주마취중적합괄용량.방법 림상병례대조연구.대2010년3～10월재정주대학제이부속의원안과수집안과행내안수술환자120례(120지안),분위4조,매조30례(30지안).조1구주주사리다잡인화포비잡인주사액등비혼합액3ml;조2、조3、조4구주주사리다잡인화포비잡인주사액등비혼합액3ml분별가투명질산매침75 U;150 U,300 U;마취전、후측량안압급주각막내피경화시망막전류도검사.결과 조1마취후교마취전안압승고,차이유통계학의의[(15.64±1.71) versus(18.09± 2.95) mmHg,P＜0.05].조2、조3、조4마취후안압균교마취전강저차이유통계학의의(16.20±1.71) versus (14.97±1.00) mmHg,P＜0.05; (16.32±1.69) versus (14.66±1.51) mmHg,P＜0.05; (16.52±1.76) versus (14.63±2.03) mmHg,P＜0.05.마취후조2、조3、조4지간안압비교차이균무통계학의의(14.79±1.00) versus (14.66±1.51) versus (14.63±2.03) mmHg;P＞0.05.마취전후각막내피경급시망막전류도검사균차이무통계학의의(P＞0.05).결론 구주마취중응용투명질산매,가이강저안내압,병차대안국부무독부반응.단기강저안압적효과병불수착투명질산매용량적증가이증강.
Objective To observe the effectiveness of addition different dosage hyaluronidase to peribulbar anesthesia mixture for lowering intraocular pressure and find the right dosage of hyaluronidase in peribulbar anesthesia.Methods A case-control prospectively study.The clinical data from 120 cases (120 eyes) undergone intraocular surgery were analyzed.The cases were divided into 4 groups randomly and there were 30 cases (30 eyes) every group.Group 1 was peribulbar anesthesia with 3ml mixed liquor of lidocaine and bupivacaine.Group 2,Group 3 and Group 4 were peribulbar anesthesia with 3ml mixed liquor of lidocaine and bupivacaine which addition hyaluronidase 75u,150u,300u,respectively.The intraocular pressure was observed,the corneal endothelial cells were counted,and electroretinogram before and after perform peribulbar anesthesia were examined.Results The intraocular pressure were increased post-peribulbar anesthesia than pre-peribulbar anesthesia in group 1 (15.64±1.71 versus 18.09±2.95mmHg,P ＜0.05).It had significant differences change between group 1 post-peribulbar anesthesia and pre-peribulbar anesthesia.The intraocular pressure were decreased post-peribulbar anesthesia than pre-peribulbar anesthesia in group 2,group 3 and group 4.(16.20±1.71 versus 14.97±1.00 mmHg,P ＜0.05; 16.32±1.69 versus 14.66±1.51 rnmHg,P ＜ 0.05; 16.52±1.76 versus 14.63±2.03mmHg,P ＜0.05),the changes had significant differences.No significant differences were found in intraocular pressure value among group 2,group 3 and group 4 post-peribulbar anesthesia (14.79±1.00 versus 14.66±1.51 versus 14.63±2.03mmHg; P ＞0.05).The changes of electroretinogram and counting of the corneal endothelial cells had no significantly different (P ＞0.05).Conclusions Hyaluronidase can effectively decrease intraocular pressure after peribulbar anesthesia.No severe adverse effect is found after addition hyaluronidase in peribulbar anesthesia.But its effects dose not increase with increasing of the dosage.