不同麻醉剂在眼科球周麻醉中镇痛及制动效果的分析

Analysis of Analgesic and Braking Effects of Different Anesthetics in Peribulbar Anesthesia

摘要: 目的：探讨不同麻醉剂在眼科球周麻醉中镇痛、制动、眶压升高等方面的差异性。方法：采取双盲随机对照的研究方法，将142名需行玻璃体视网膜手术的患者随机分为三组：0.75%罗哌卡因组、0.75%布比卡因组以及2%利多卡因混合0.75%布比卡因组，混合1%透明质酸酶后，由固定的一名手术医师行等量的球周神经阻滞麻醉(7 ml)，每隔30秒记录镇痛效果、各方位制动效果、眶压升高与否、球结膜是否水肿及出血等指标。结果：统计显示，三组麻醉剂在镇痛效果、各方位制动效果、眶压升高与否、球结膜水肿及出血等方面不存在显著差异性(P > 0.05)；三组麻醉剂均显示水平位制动起效时间迟于垂直位(P < 0.05)。麻醉后眶压是否升高与平视时睑裂宽度及长宽乘积呈正相关(P = 0.01、P = 0.006)。结论：临床常规使用的三种麻醉剂在眼科球周麻醉中都能起到良好的镇痛及制动效果；球周麻醉后的水平位制动需更长的麻醉时间，其中内侧位制动往往最后发生；同时，平视时拥有更高的睑裂宽度及睑裂面积的患者，发生眶压升高的概率较低。

Abstract: Objective: To analyze the difference of several anesthetics in peribulbar anesthesia. Method: A double blind, randomized controlled study was used. 142 patients with vitreoretinal surgery were divided into 3 groups: 0.75% ropivacaine group, 0.75% Bupivacaine group and 2% lidocaine with 0.75% Bupivacaine mixed group. The peribulbar anesthesia was performed by one fixed surgeon and the messages were recorded every 30 seconds. Results: There was no significant difference between 3 groups (P > 0.05). The time to stop rotate in horizontal position was longer than vertical position in all 3 groups (P < 0.05). The increase of orbital pressure after anesthesia is positively correlated with the palpebral fissure width and the product of length-width in head-up vision (P = 0.01, P = 0.006). Conclusion: All 3 kinds of anesthetics used in the clinic work well in peribulbar anesthesia. It will take more time in horizontal position to stop rotate and the medial brakes often occur at the end. The patients with larger palpebral fissure width and the product of length-width will own less increase of orbital pressure.