眼心反射的临床观察

由于眼科手术诱发的眼心反射(简称OCR)。可引起明显的心脏功能改变.甚至停搏.我们用动态心电图仪(Holter).观察40例48次手术.结果如下。术前20分钏给病人安放Holter记录盒。从麻醉开始详细记录每一手术步骤的时间.术后用Holter分析仪进行还原扫描分析,将阴性OCR与手术记录时间相对照.确定OCR发生于哪一手术步骤. 出现以下情况均为OCR阳性:①窦性心率瞬间减慢10次或10次以上;②术中新出现的心律失常或术中出现的心律失常平均每小时次数大手术前;③术中出现     

迷走神经张力状态与眼心反射

眼外肌手术时发生缓脉及心律失常称为眼心反射(Oculo-Cardiac reflex以下简称OCR)。Kirch等称为三叉神经迷走神经反射。国内外文献已有不少有关OCR的报道及严重OCR引起心脏停搏的个案报道。OCR的防治已成为眼科医师十分关注的问题。我们又于1985年-1986年5月、对100名施行眼外肌手术的患者进行了迷走神经张力状态的测定,并对术中可能发生的OCR进行了前瞻性研究,旨在1)探讨     

老年白内障患者术中眼心反射的观察与护理

目的探讨老年性白内障患者手术中眼心反射的发生情况及护理方法。方法使用美国产Gode，Master心电监护仪观察记录106例（126眼）年龄在65～80岁的老年性白内障患者术中心率变化，并与基础心率相比较，分析眼心反射发生的情况。结果眼心反射主要在加压软化眼球时，发生率为32．08％（34／106）。其中，男性眼心反射发生率为40．39％（21／52），女性为24．07％（13／54）。结论老年白内障患者手术中有眼心反射发生的风险，值得手术医护人员的重视。     

眼科手术及麻醉所致眼心反射的观察

眼心反射是三叉神经──迷走神经反射，牵拉眼睑、虹膜、眼肌及压迫眼球均可发生。虽然此类心律失常多数多无临床意义．但其中亦难免有性质严重者，故应引起重视。我们对8例行眼科手术的患者，术中进行心电监测，以了解眼科麻醉后手术操作对眼心反射的作用。临床资料l．一般情况：患者8例．ASAI一2级．男5例．女3例；年龄7～6（）岁，平均31岁。既往无肝、肾病史。术前检查肝、肾功能正常，ECG在正常范围，无心律失常。在高麻或全麻下行择期手术。全麻小儿术前肌往阿托品0．cling／kg。局麻药为2％利多卡因与0．75％布比卡因混合液。2．…     

门诊眼科治疗中严重眼心反射的预防救治探讨

目的探究眼科治疗中严重眼心反射的发生原因，从而进行有效的预防，降低眼科门诊的护理风险；方法对眼科治疗中发生的两例严重眼心反射致心脏骤停患者的救治过程进行回顾性的分析和探讨；结果在治疗中眼局部疼痛和压力的刺激下，患者产生对眼科治疗的紧张和恐惧、坐位治疗的情况下发生了严重的眼心反射；结论为了防止治疗中严重眼心反射的发生，眼科治疗护士治疗前应该做好患者的心理护理，治疗时操作轻柔，尽可能减少对眼的刺激，平卧位治疗以增加患者的心脑供血并执行严密的病情观察，及早发现严重眼心反射的先兆症状，及时有效救治。     

眼的神经性反射运动

眼的神经性反射运动山东省立医院眼科（２５００２１）北京市眼科研究所王利华鹿庆人类在清醒状态时，有许多涉及眼的神经性反射运动参与控制和调整眼球的位置。这些反射运动已经建立起了完善的行为反射模式，但也在很大程度上受着随意运动的控制和影响。眼的神经性反射运...     

眼球摘除术中严重眼心反射二例

眼心反射（OCR）是眼科常见并发症,斜视手术中的发生率为80％。据统计,15岁以下儿童眼心反射发生率为90％,成人约50％。多数为一过性,能自行恢复,少数严重者可危及生命。例1女,32岁。因右眼外伤后失明、眼眶凹陷畸形10余年于2014年7月16日入院。既往体健。查：T36．5°,P76次,min,R22次／min,BP110／70mmHg。VodNLP,Vos 1．0。     

球后麻醉及阿托品预处理对小儿斜视手术眼心反射的影响

目的:比较全身麻醉、全身麻醉联合球后麻醉或阿托品三种麻醉方法对小儿斜视手术眼心反射(oculocardiac reflex,OCR)发生率的影响.方法:将2015-03/2016-03在我院行斜视矫正手术并采用全身麻醉的5~13岁患者92例166眼纳入研究,随机分为全身麻醉组29例55眼、全身麻醉+球后麻醉组31例54眼、全身麻醉+阿托品组32例57眼;全身麻醉组采用静脉注射丙泊酚2 mg/kg、芬太尼1 mg/kg和阿曲库铵0.5 mg/kg.全身麻醉+球后麻醉组于全身麻醉基础上球后注射20 g/L利多卡因2 mL.全身麻醉+阿托品组于全身麻醉基础上于术前加用静脉注射阿托品0.15 mg/kg.手术期间牵拉眼外肌所造成的最低心率低于心率基线值的10%以上或出现心律失常即为OCR阳性.记录术前心率基线值,术中手术时间、麻醉时间及术中OCR发生的肌肉数,术后随访6 mo并记录眼球正位例数.结果:全身麻醉+球后麻醉组的OCR发生率最低(20%),其次为全身麻醉+阿托品组(22%),两种麻醉方法OCR发生率均低于全身麻醉组(58%).三种麻醉方法在麻醉时间、手术时间、心率基线值以及手术后眼位正位率方面无统计学差异(P>0.05).结论:小儿斜视全身麻醉手术联合球后麻醉或阿托品预处理,可有效地降低术中OCR的发生率,能够为斜视患儿提供更安全的手术保障.     

斜视术中不同麻醉方式对眼心反射影响的观察

目的探讨斜视手术中不同的麻醉方式眼心反射发生率的差异及其临床意义。方法将84例斜视患者根据手术需要分为局麻组和全麻组,两组患者再随机分为传统麻醉组及传统麻醉联合球后麻醉组,记录勾取眼外肌前后心率变化,按照不同的麻醉方式对眼心反射发生的阳性率进行了临床观察。结果全麻患者眼心反射发生的阳性率明显低于局麻,无论患者是全麻还是局麻,球后麻醉均可有效降低眼心反射的发生率,术后呕吐的发生率也相对较低。结论在传统麻醉的基础上联合球后麻醉可以减少眼心反射的发生,有效提高斜视手术安全性。     

全麻儿童眼肌手术的眼心反射

眼心反射早在1908年由Aschwer和Degnini首先 报道。以往有文献从不同角度对眼心反射作过一些描述,并且认为15岁以下儿童眼心反射发生率高于成人,全麻多于局部。而严重眼心反射也可导致死亡。我们综合国内诊断眼心反射阳性标准并加以分级,同时深入分析眼心反射的发生情况,这对预防和处理眼心反射有一定的临床指导意义。现从1990年1月—1997年6月对93例全麻儿童眼肌手术中眼心反射进行回顾性总结,报道如下:     

Reduction of oculocardiac reflex with Tetracaine eye drop in strabismus surgery

Introduction: Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The present study evaluated the effects of Tetracaine eye drop as a topical nerve blocker on OCR during strabismus surgery.

Methods and materials: In this randomized trial, 70 strabismus surgery candidates were randomly divided into placebo or synthetic teardrop (E) and Tetracaine eye drop (T) groups, so 3 drops of each solution were dropped in four directions of patients’ eye immediately after applying anesthesia and before surgery. The incidence and severity of OCR during the stages of muscle release and incision (cutting), hemodynamic changes, the required time for OCR recovery and atropine dose were assessed.

Results: OCR was more seen in release phase compared to cutting phase. There were no significant differences between two group regarding the incidence and severity of OCR in the release phase (p > 0.05), but the incidence and severity of OCR in the cutting phase was more in group E than group T (p = 0.02, for both). The duration of OCR improvement (p-value = 0.74) and Atropine consumption (p-value = 0.92) did not differ between the groups.

Conclusion: Tetracaine eye drop only reduces the incidence and severity of OCR during the incision stage of strabismus surgery.     

Oculocardiac Reflex during Strabismus Surgery: Experience from a Tertiary Hospital

Purpose: To evaluate the incidence of the oculocardiac reflex (OCR) and its associated risk factors during strabismus surgery at a tertiary referral center.

Methods: Over a 2-year period, all strabismus surgery candidates were enrolled in the study. OCR was defined as heart rate reduction ≥15% after traction on extraocular muscle(s). The rate of OCR was determined and possible associations were explored. Variables included age, gender, type of strabismus, nature of surgery (weakening versus strengthening), specified extraocular muscle, times of surgery, and the sequence of operated muscles (eg, first, second, or third operated muscle). We avoided the use of atropine pre- and postoperatively.

Results: Seventy-six patients with mean age of 15±12 years were enrolled; 51.3% of subjects were male. OCR occurred in 65 out of 76 (85.5%) patients and with 84 out of 173 (48.6%) operated muscles. OCR was more common in subjects less than 20 years of age; however, it showed a decreasing trend afterwards. OCR was more frequent during operation on cyclovertical muscles than horizontal recti (P=0.02). Moreover, during procedures on horizontal rectus muscles, OCR was more common if baseline heart rate was more than 61 (P=0.008). OCR was not correlated with gender, type of strabismus, nature of surgery, times of the surgery, or the sequence of operated extraocular muscles.

Conclusions: The great majority of patients undergoing strabismus surgery, especially younger subjects, those undergoing operation on cyclovertical muscles, and subjects with higher baseline heart rate, experience OCR during strabismus surgery. During surgery on cyclovertical muscles, the amount of pull is usually more due to more difficult exposure.     

Surgical and anesthetic influences of the oculocardiac reflex in adults and children during strabismus surgery

One of the most common untoward occurrences during strabismus surgery at all ages is the oculocardiac reflex. Although typically easily treated, the sudden bradycardia or cardiac arrest may add a few gray hairs to ophthalmologists and anesthesiologists alike as it can be potentially fatal. This updated review of the literature and novel detailed treatment algorithm may prevent patient morbidity and mortality through proper recognition of at-risk patients and rapid treatment through proper communication between surgical and anesthesia physicians/providers.     

局部麻醉对兔眼心反射和眼角膜愈合的影响(英文)

目的:在兔模型中利用局部麻醉来研究两种麻醉剂的眼心反射发生率及其预防,同时我们还研究了局部麻醉对角膜愈合的影响。方法:健康的成年新西兰白兔(雌雄皆有)48只,分成两组(A组和B组),分别用氯胺酮(A组,24例)、异丙酚(B组,24例)麻醉。在此双盲研究中,通过用或不用局部麻醉(40g/L利多卡因,5g/L盐酸丙美卡因,5g/L布比卡因)对眼睛的不同干预,记录各组眼心反射发生率。应用每种局部麻醉后,通过对眼睛的临床检查,组织病理学,胶原染色以及投射电子显微等方法对术后1d长达7d角膜毒性和愈合进行评估。结果:在氯胺酮的麻醉下未出现眼心反射,而在异丙酚的麻醉下,心率显著下降(P<0.01)。因此,局部麻醉可以成功地防止眼心反射的发生并且不影响角膜愈合。结论:局部麻醉没有任何局部副作用,可以被推荐用来预防眼心反射。     

Oculocardiac reflex in phacoemulsification: Peribulbar vs topical anesthesia

Purpose:This study compares the vital parameters and pain experienced during phacoemulsification under peribulbar and topical anesthesia to determine the incidence of OCR.Methods:One hundred six patients are enrolled for phacoemulsification in a prospective and randomized study. Fifty-two patients undergo surgery in a peribulbar block (Group PB) and 54 in topical anesthesia (Group TA). Mean arterial pressure (MAP) and pulse rate are recorded during a preoperative check-up and at four other steps of surgery. Pain experienced during surgery and on a postoperative day, 5, is graded with a verbal analogue scale. OCR defined as a decrease in pulse rate by greater than 20% is calculated. Chi-square test, Fisher‘s exact test, paired t test and the comparison of means give the statistical analysis. A value of P < 0.05 was taken as significant.Results:MAP readings at baseline versus MAP at other steps of surgery show a trend towards rising with a P value of < 0.05 in both groups. Pulse rate measured at all steps of surgery versus baseline pulse rate in Group TA shows P < 0.05. OCR is present in nine patients in peribulbar block verses eleven patients in topical anesthesia with P value of 0.687. The pain scores using verbal analogue scale were higher in Group TA compared with Group PB with a P < 0.0001.Conclusion:Oculocardiac reflex can occur during phacoemulsification under both peribulbar block and topical anesthesia, and the difference is not significant.     

Influence of topical anesthetics on oculocardiac reflex and corneal healing in rabbits

AIM: To investigate the incidence of oculocardiac reflex (OCR) with two anesthetic regimens and its prevention using topical anesthetics in a rabbit model, and to explore the effect of topical anesthetics on corneal healing. · METHODS: Forty-eight clinically healthy adult New Zealand white rabbits of either sex were divided into two groups (Group A and B) and anesthetized with either ketamine (Group A, n =24) or propofol (Group B, n =24). he incidence of OCR was recorded in each group with a variety of ocular manipulation with or without the use of topical anesthetics (40g/L lignocaine, 5g/L proparacain, 5g/L bupivacaine). Corneal toxicity and healing following the use of each topical anesthetic was assessed one day after surgery and up to 7 days postoperatively by clinical examination of the eye, histopathology and collagen staining and transmission electron microscopy. · RESULTS: No incidence of OCR was recorded with ocular manipulation under ketamine anesthesia, whereas significant reduction in heart rate (P <0.01) was recorded under propofol anesthesia. Topical anesthetics could successfully prevent the OCR without affecting the corneal healing. · CONCLUSION: Topical anesthetics may be recommended for prevention of OCR without any local adverse effect.     

Electrocardiographic changes during subconjunctival injections

Electrocardiographic changes were investigated in 53 patients duringsubconjunctival drug injections. Decrease in heart-rate of more than10% or arrhythmia was observed in 25 (47.2%) of the patients, whowere considered to have a positive oculocardiac reflex. In the control group of 35 patients, only 3 (8.6%) were found to have a significant decrease in heart rate during blood sampling from antecubital vein (p = 0.000). Young age was a significant risk factor for oculocardiac reflex during injections (p = 0.01). Patient gender, verbal pain score, satiety, experience of periocular injections, injected drug type were not found to be risk factors. All patients with oculocardiac reflex were asymptomatic; however, it is still wise to have emergency supplies readyfor any circulatory derangement during subconjunctival injections.     

眼外伤与眼心反射

目的　了解眼外伤对心脏的间接影响 ,评估创伤性眼心反射的临床意义。方法　回顾性分析 65 7例眼外伤住院患者的血压、脉博及部分心电图变化。结果　伤后 1小时内首次平均动脉压低于 70mmHg者 7例 ( 2 2 7% ) ( 1mmHg =0 13 3kPa) ;首次脉搏较基础频率减慢者 14例 ( 4 5 4% ) ,二者同步 1例。异常心电图 2 17例 ( 5 6 66% ) ,眼挫伤比眼烧伤发生异位心律失常明显增多 (P <0 0 5 ) ;窦性心动过缓 ,异位心律失常与ST -T异常心电图以 40岁以上年龄段多见 (P <0 0 5 )。结论　眼外伤导致血压下降甚微且与脉搏减慢无同步关系 ;心脏植物神经功能的稳定性受到伤情影响 ;窦性心动过缓、异位心律失常及ST -T异常发生与年龄段密切相关。应加强创伤性眼心反射的防治 ,注重 40岁以上年龄段     

Effects of age, viewing distance and target complexity on static ocular counterroll

The ocular counterroll (OCR) reflex generates partially compensatory torsional eye movements during static head roll tilt. We assessed the influence of age, viewing distance and target complexity on the OCR across the age span (13-63 years; n = 47), by recording eye movements during head-on-body roll tilt (0 ± 40° in 5° steps) while subjects viewed simple vs. complex targets at 0.33 and 1 m. We found that subjects ?31 years had lower gains than those ?30 years, but only for far targets. Consistent with prior reports, far targets elicited higher OCR gains than near targets, and target complexity had no effect on gains, suggesting that visual input is primarily used to maintain vergence during OCR.