有晶状体眼后房型人工晶状体植入术后患者在不同瞳孔状态下的眼前段变化

目的 观察有晶状体眼后房型人工晶状体(ICL)植入术后患者在缩瞳与散瞳状态下眼前段参数的变化.方法 自身对照研究随机选取ICL植入术后2周以上的患者10名(19眼),滴1％毛果芸香碱或复方托吡卡胺分别建立缩瞳和散瞳状态下的模型,然后采用眼前段光学相干断层扫描仪分别测量自然状态、缩瞳状态和散瞳状态下的前房深度、ICL拱高及角膜白对白间距等眼前段相关参数.对相关数据进行配对f检验.结果 自然状态、缩瞳和散瞳后的前房深度分别为(3.61±0.20)mm、(3.42±0.15)mm和(3.64±0.22)mm,缩瞳状态下的前房深度较自然状态浅,差异有统计学意义(t=7.89,P＜0.01),散随状态下的前房深度与自然状态无明月显差异.自然状态、缩瞳和散瞳后的ICL拱高分别为(0.61±0.14)mm、(0.41±0.10)mm和(0.64±0.14) mm,缩瞳状态下的ICL拱高较自然状态明显降低,差异有统计学意义(t=10.51,P＜0.01),而散瞳状态下的ICL拱高与自然状态相比差异无统计学意义.自然状态、缩瞳和散瞳后的角膜白对白间距分别为( 11.40±0.28)mm、(11.38±0.32 )mm和(11.35±0.30)mm,差异均无统计学意义 结论 ICL植入术后患者的眼前段参数在缩瞳(类似处于强光环境)与散瞳(类似处于暗光环境)状态下的变化可保持在安全范围内.     

眼科门诊飞蚊症200例检查诊断分析

目的探讨视力正常（矫正正常）主诉飞蚊症患者内眼的生理病理改变。方法对门诊眼科主诉飞蚊症患者进行视力、验光、裂隙灯、扩瞳眼底检查、眼B型超声、血液化验等项检查。结果200例有飞蚊症的患者中,122例查出各种病理体征,占总人数的61％。78例有飞蚊症患者视力无影响,未查出病理体征,占总人数的39％。结论对门诊眼科视力正常（矫正正常）飞蚊症患者应扩瞳查找病因,不应一概而论为生理性飞蚊症,以免误诊。     

溴化N-甲基阿托品扩瞳与睫状肌麻痹作用的实验研究

溴化N-甲基阿托品(简称AMB),家兔扩瞳试验和离体猫睫状肌麻痹试验证明:AMB有较强的扩瞳作用;对由乙酰胆碱引起的睫状肌收缩,松弛效果快,强于硫酸阿托品、氢溴酸、后马托品和妥品酰胺。AMB对睫状肌的结合力远小于阿托品和后马托品,稍大于妥品酰胺。说明AMB属一种速效、短效的扩瞳与睫状肌麻痹剂。     

Action of opioid agonist-antagonist drugs on the pupil and nociceptive responses in mice

Opioid derivatives with mixed agonist-antagonist activities are becoming increasingly more popular in analgesia. We tested the mydriatic and analgesic activity of morphine in mice in comparison with similar effects of three agonist-antagonist agents: buprenorphine, butorphanol and nalbuphine. We also examined the antagonistic action of these three drugs by evaluating the analgesia and mydriasis in animals pretreated with morphine.The analgesic effect was assayed using the hot plate method while the pupillary responses were measured with a binocular operating microscope.Morphine produced dose-dependent mydriasis and analgesia in mice. The morphine-type agent buprenorphine and two nalorphine-type agonist-antagonists, butorphanol and nalbuphine, caused agonistic mydriatic and analgesic effects, usually less effective then morphine. Buprenorphine proved to have higher agonist activity than butorphanol and nalbuphine. The difference between butorphanol and nalbuphine was not statistically significant.A correlation between the mydriatic and the analgesic activity, known to exist among opioid derivatives with agonist activity only, was also demonstrated in the three investigated agonist-antagonist agents.Morphine-induced mydriasis and analgesia were reversed by all three agonist-antagonist drugs, but buprenorphine is a significantly weak antagonist in comparison with butorphanol and nalbuphine. An antagonistic property (antimydriatic and antianalgesic effects after pretreatment with morphine) of both nalorphine-type investigated drugs was not statistically significant, except for the antianalgesic effect of nalbuphine in doses 1 and 3mg·kg^–1, which was higher in comparison with butorphanol.(Stav A, Rabinowitz R, Korczyn AD: Action of opioid agonist-antagonist drugs on the pupil and nociceptive responses in mice. J Anesth 6: 439–445, 1992)     

硬膜外血肿手术后脑水肿临床多因素分析

目的探讨硬膜外血肿患者实施手术后发生脑水肿的相关危险因素。方法将50例急性硬膜外血肿患者按照手术后有无脑水肿分为水肿组（n=24例）和正常组（n=26例）。对两组患者进行格拉斯哥昏迷评分（GCS评分）,记录两组患者的年龄、性别、瞳孔大小、脑中线位移情况、血肿量、有无基础疾病、血压有无升高等可能的相关危险因素,对这些患者的临床资料中可能导致脑水肿的危险因素进行Logistic回归分析。结果两组患者年龄、性别、基础疾病比较差异无统计学意义,但术前GCS评分、瞳孔散大、血肿量、脑中线位移程度、血压有元升高、手术是否拖延比较差异有统计学意义。经logistic回归分析统计瞳孔散大、血肿量大、血压升高、手术拖延是导致脑水肿的危险因素。结论经硬膜外血肿手术后的患者极易发生脑水肿,为防止脑水肿的发生,应仔细观察患者有无血压升高、瞳孔有无散大并尽早手术,这样才能减轻手术后脑水肿的发生,有效改善患者的预后。