眼球筋膜囊下麻醉在斜视手术中眼心反射观察

目的观察眼球筋膜囊下麻醉对局部麻醉下斜视手术中的眼心反射(OCR)影响。方法选择80例局部麻醉手术的水平性斜视患者,分成实验组和对照组各40例,用0.75%罗哌卡因混合2%利多卡因分别作眼球筋膜囊下麻醉和结膜下浸润麻醉,并记录扣取肌肉时OCR的发生情况。结果 80例患者均能在局部麻醉下顺利完成手术,实验组牵拉内直肌36条,发生OCR 16次,牵拉外直肌38条,发生OCR 10次;对照组牵拉内直肌38条,发生OCR 26次,牵拉外直肌38条,发生OCR 22次,两组间牵拉肌肉引起的OCR发生率差异有显著统计学意义(实验组35%,对照组63%,P<0.05),而两组间OCR等级差异无显著统计学意义(P>0.05)。结论眼球筋膜囊下麻醉在局麻斜视手术中具有较低OCR发生率,是一种安全有效的斜视手术麻醉方法,值得推广应用。     

罗哌卡因利多卡因混合液眼球筋膜囊下麻醉在斜视手术中的应用研究

目的：评价罗哌卡因利多卡因混合液眼球筋膜囊下麻醉在斜视手术中应用的优越性。

方法：选择80例局部麻醉手术的水平性斜视患者,分为试验组和对照组,用7.5g/L罗哌卡因混合20g/L利多卡因分别作眼球筋膜囊下麻醉和结膜下浸润麻醉,并进行疼痛和眼心反射的评估。

结果：患者80例均能在局部麻醉下顺利完成手术,疼痛的评估结果：根据视觉模拟评分法(VAS),试验组评为“优”者12例,“良”者21例,“可”者6例,“差”1例。对照组“优”者2例,“良”者25例,“可”者12例,“差”1例。两组进行秩和检验,P<0.01,两组有显著差异。术中牵拉眼内外直肌数量和出现眼心反射情况为：试验组牵拉肌肉共74条,发生眼心反射26次,对照组牵拉肌肉共76条,发生眼心反射48次,采用χ²检验,P<0.01,两组间眼心反射发生率差异有统计学意义。两组间眼心反射等级差别采用秩和检验,P>0.05,在发生眼心反射患者中,两组间眼心反射等级分布差异无统计学意义。

结论：应用7.5g/L罗哌卡因混合20g/L利多卡因作眼球筋膜囊下麻醉在斜视手术应用有一定的优越性,值得推广应用。     

成人斜视术中联合静脉给药减少眼心反射的发生率

目的成人斜视手术中联合静脉给药,可减少眼心反射引起的心率变化。方法2005年7月～2006年6月,我科接受斜视手术的成年患者87例,其中术中仅用0.5%盐酸丙氧苯卡因(爱尔卡因)点眼表面麻醉者42例,同时接受0.5%盐酸丙氧苯卡因点眼联合静脉给药者45例,所有患者既往无心血管疾病史,术前全身常规检查均未见异常。记录牵拉直肌前后的心率变化,比较二者的差异性。结果单纯表面麻醉组,牵拉肌肉后心率减慢10次/分以上,牵拉前后心率比较,差异有显著性P<0.05,联合静脉给药组,虽然牵拉肌肉后心率增加,牵拉前后心率比较,差异无显著性P>0.05。结论在成人斜视术中联合静脉给药,可以减少眼心反射的发生,缓解患者紧张情绪及减轻疼痛感。     

眼外肌延长术联合拮抗肌折叠术矫正大角度外斜视

采用眼外肌延长术联合拮抗肌折叠术矫正大角度外斜视３０例，证实眼外肌延长术能使肌张力以最大限度放松，达到外直肌后徒１０～１２ｍｍ的效果，在矫正大角度斜视中起良好作用，且可减少肌折叠长度，避免用力牵拉眼肌所致眼心反射。治疗良好率达８６．６６％。是一种简单、快速、安全、有效的手术方法。     

单眼直肌手术治疗成人知觉性外斜视临床观察

目的：评估单眼直肌手术治疗成人知觉性外斜视的效果。

方法：选取76例76眼Krimsky法度数为-15^△～-160^△(-68.36±30.77)^△的成人知觉性外斜视患者纳入本次研究。分别使用常规量单眼外直肌后徙、常规量单眼内直肌缩短+外直肌后徙和超常量单眼内直肌缩短+外直肌后徙三种术式,对16例、37例以及23例不同斜视度数的患者进行治疗。术后1d,1wk,1、3、6mo进行随访,检测患者眼位情况、单眼运动情况、眼压、裂隙灯和眼底。

结果：术后67例(88%)眼位正,9例(12%)欠矫。术后1wk术眼眼压与术前持平(P=0.090),至3mo时眼压下降达峰值(P<0.01),3mo眼压与1mo差异无统计学意义(P=0.092),6mo眼压与3mo差异无统计学意义(P=0.123)。2例(3%)患者在术后1d,1wk随访时出现前节缺血导致的炎症反应,至1mo随访时均痊愈。4例(5%)患者术后1、3、6mo随访时出现眼球外转功能不良。

结论：单眼直肌手术对于成人知觉性外斜视患者有较好的治疗效果; 离断眼直肌继发的眼压下降现象值得术者警惕; 单眼离断2条直肌手术后并发症的发生率较低; 超常量眼直肌斜视矫正术治疗知觉性外斜视可能出现术后眼球极度外转的功能受限。     

不同麻醉下视网膜脱离手术中的眼心反射观察

目的:观察不同麻醉方法下视网膜脱离外路手术中的眼心反射。方法:选取我科2008-06/2010-03住院患者109例109眼,随机分为对照组和治疗组,分别采用球后阻滞麻醉与静脉复合麻醉进行视网膜脱离外路手术,观察术中血压、心率、眼心反射、血氧饱和度等情况。结果:与球后阻滞麻醉比较,静脉复合麻醉下眼心反射发生率低,收缩压、舒张压及平均血氧饱和度变化较小,经统计学处理,差异有统计学意义(P<0.01)。结论:静脉复合麻醉下行视网膜脱离外路手术相对安全,并发症少,效果满意。     

甲状腺相关眼病眼眶减压术后继发内斜视伴复视的手术疗效观察

目的探讨甲状腺相关眼病(TAO)眼眶减压术后继发内斜视伴复视的斜视矫正手术治疗效果。方法回顾性系列病例研究。选取2016年3月至2018年10月在天津市眼科医院因TAO行眼眶减压术后继发内斜视伴复视行斜视矫正手术治疗的11例患者资料。斜视矫正手术前、后检查患者斜视度数、眼球运动,观察复视情况。手术均在监护下麻醉联合局部麻醉下进行,术中采用被动牵拉试验结合调整缝线方法,调整至第一眼位复视消失。术后定期随访。结果11例患者中男性1例,女性10例;年龄26~42岁;均为单纯内斜视伴复视;内斜视度数10~98三棱镜度;眼眶CT提示患者内直肌不同程度增厚,外直肌增厚程度较内直肌轻。2例患者行单眼内直肌后徙术,2例行双眼内直肌后徙术,2例行单眼内直肌后徙联合外直肌缩短术,另外5例行双眼内直肌后徙联合单眼外直肌缩短术。11例患者术中内直肌后徙量为3.5~7.5 mm,7例联合外直肌缩短术患者外直肌缩短量为2.0~6.0 mm。全部患者术后复视消除,第一眼位正位,均达到治愈标准。眼球运动术前外转受限分级为(-1.91±1.04)级,术后外转受限分级为(-0.64±0.81)级。11例患者均对手术结果满意,术后随访6~24个月,效果稳定,未发现远期过矫患者。结论应用术中调整缝线技术,斜视矫正手术可以有效治疗TAO眼眶减压术后继发的内斜视伴复视。     

斜视矫正术后眼心反射一例

斜视矫正术后眼心反射一例钟兆贝在眼科，由于牵拉眼球或压迫眼球等操作可引起心率相对减慢、或各种心律失常的表现，称为眼心反射。眼心反射常在眼外肌手术时发生，此外，也见于白内障摘除手术时压迫眼球（降低眼压措施）以及眼球摘除手术和眶内容摘除手术时等，每分钟心...     

眼心反射在不同斜视手术中的临床表现

牵拉眼外肌可使心率减慢 ,这种现象首先为As chner和Dagnin于 1 90 8年发现[1] 。以后人们把眼受机械刺激引起迷走神经过度兴奋而导致心律失常的现象称眼心反射。加压眼球或牵拉眼外肌后心率减慢 1 0次以上者称为阳性眼心反射 ,严重者每分钟可减缓 60次 ,甚至停止心跳而死亡。对象和方法　本文 40例共同性内、外斜视患者 ,术前心电图检查均正常。第一组 :2 0例共同性内斜视 ,男性 1 1例 ,女性 9例 ,年龄 9～ 1 2岁 ,行内直肌后徙术。第二组 :2 0例共同性外斜视 ,男性 1 0例 ,女性 1 0例 ,年龄 9～ 1 1岁 ,行内直肌缩短术。均在心电监护仪监…     

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。     

The oculocardiac reflex as a surgical aid in identifying a slipped or ''lost'' extraocular muscle.

The oculocardiac reflex during strabismus surgery has generally been regarded as a hazard capable of causing death. Six cases are presented which show a beneficial use of the oculocardiac reflex. Isolation of a previously slipped or 'lost' extraocular muscle can be difficult. In this series identification of the tissue as muscle was substantiated by observing a positive oculocardiac reflex when traction was placed on the suspected tissue. Each of the 6 dislodged extraocular muscles was the medial rectus muscle. Three of the muscles had been resected and 3 either recessed or tenotomised. In one patient, despite 6 previous strabismus operations, including 2 strabotomies on a muscle that slipped, and in another patient, who had a lapse of 6 years since the last strabotomy, when the slipped muscle was isolated, the oculocardiac reflex could still be elicited. To avoid abolishing the oculocardiac reflex during surgery the anaesthetist should be instructed to avoid the use of an intravenous parasympatholytic agent, such as atropine, at the time of induction and during the operation.     

The oculocardiac reflex in strabismus surgery

During strabismus surgery on 81 extraocular muscles in 49 children the cardiac response to calibrated traction on each of the muscles operated on was studied through the use of a microdisplacement transducer and the tachometer of a cardiac monitor. There was no significant difference in the frequency of induction of the oculocardiac reflex between the medial rectus and the other muscles or between the two eyes. However, quick traction provoked a reflex in 87% of instances, whereas progressive traction did so in only 51% of instances, a significant difference (p less than 0.05). Thus, because the oculocardiac reflex is frequent during strabismus surgery, cardiac monitoring during the operation and minimal, gentle manipulation of the extraocular muscles are important.     

Quantitative analysis of the oculocardiac reflex by traction on human extraocular muscle

The oculocardiac reflex was quantitatively studied in 15 patients with strabismus. The reflex was observed in all patients when the medial rectus and inferior oblique muscles were stretched; the medial rectus muscle had a lower threshold than the inferior oblique. Bradycardia was evoked in 7 of the 15 patients when the lateral rectus was tractioned with tensions of 50 g and 600 g. The oculocardiac reflex was a graded phenomenon as a function of tension applied to the extraocular muscles. As tension was increased, bradycardia occurred rapidly and became deep. Systemic administration of atropine prevented completely the bradycardia from occurring. The results suggest that the response of the extraocular muscles to stretch are critically mediated through a polysynaptic path to the heart, resulting in suppression of the heart rate.     

Asystole due to the oculocardiac reflex during strabismus surgery: a report of two cases

The oculocardiac reflex is a well-known entity which may result in vagal depression of the heart when pressure is placed on the eyeball or when traction is applied to the extraocular muscles. Bradycardia is, by far, the most common cardiac response to these stimuli. We report two cases of ten-second episodes of asystole during traction on the medial rectus muscle as a reminder to ophthalmologists and anesthesiologists alike that this complication can and does occur during 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.     

A型肉毒毒素辅助治疗Graves眼病的临床观察

目的通过对存在恶性突眼的Graves眼病患者受累眼外肌进行A型肉毒毒素注射治疗,观察注射后眼位偏斜及复视恢复的情况,探讨A型肉毒毒素辅助治疗Graves眼病的机理及实用价值。方法选取我院确诊为伴有恶性突眼的Graves眼病合并眼位偏斜的患者31例(其中伴有水平偏斜者15例,伴有垂直偏斜者30例)。患者进行眼眶CT扫描、同视机、HESS屏和斜视度测定等检查后,对其所受累的眼外肌(下直肌24条,内直肌11条,上直肌6条,上睑提肌4条)在肌电图的指引下进行多次重复的A型肉毒毒素肌腹内注射。定期随诊观察注射后的眼位变化及复视程度的变化。结果31例接受A型肉毒毒素眼外肌注射的患者中,在经过重复注射2~6次后,其斜视度及复视程度均有不同程度的减轻。总体显效率41.9%,有效率51.6%,无效率6.5%.结论A型肉毒毒素眼外肌内注射是一种能有效缓解Graves眼病患者眼外肌挛缩和减轻复视症状及斜视度的治疗方法。在疾病早期及时应用A型肉毒毒素进行受累眼外肌注射,并适当联合全身或局部激素、免疫抑制剂治疗,对于控制Graves眼病的临床症状可以收到满意的疗效。     

共同性斜视眼外肌病理分析

目的探讨共同性斜视眼外肌的病理变化与斜视发生的关系。方法对132例共同性斜视和22例麻痹性斜视病人行斜视矫正手术,将截除的外直肌或内直肌用95%酒精固定后送病理,在显微镜下观察眼外肌的组织结构。结果81例共同性外斜视中,内直肌退行性改变57例(70.4%),内直肌纤维化10例(12.3%),内直肌玻璃样变10例(12.3%),正常4例(4.9%);51例共同性内斜视中,外直肌退行性变18例(35.3%),外直肌纤维化28例(54.9%),外直肌玻璃样变5例(9.8%),22例麻痹性斜视中,13例内直肌和3例外直肌发生纤维化,6例外直肌发生玻璃样变。共同性斜视与麻痹性斜视直肌的病理结果经X~2检验P<0.01。恒定性外斜视与间歇性外斜视之间及先天性内斜视与共同性内斜视之间经X~2检验P<0.05。结论斜视的发生与眼外肌的结构异常有关,发病较久的恒定性外斜视比发病晚的间歇性外斜视其眼外肌发生纤维化的百分比较大,说明内直肌纤维化可能是外斜视形成的原因之一,斜视的病变程度与眼外肌功能是成反比的。     

共同性外斜视眼外肌病理研究

目的：探讨共同性外斜视内直肌的病理变化与斜视发现时间的关系。
　　方法：对30例共同性外斜视患者行斜视矫正手术,术中将截除的内直肌用4%甲醛固定后送病理,在显微镜下观察眼外肌的组织结构,并进行HE和Masson染色。
　　结果：共同性外斜视30例中,内直肌纤维大小不一、形态异常,数量减少,肌肉不同程度的纤维化,经Masson染色后发现,发现斜视较久患者组眼外肌肌纤维含量明显少于发现时间较短患者组(P<0.05) 。
　　结论：斜视的发生与眼外肌的结构异常有关,发现斜视时间较久的共同性外斜视比发现时间较短的共同性外斜视其眼外肌发生明显的纤维化,说明内直肌纤维化可能是外斜视形成的原因之一。随着斜视时间的延长,眼外肌纤维化程度加重。