成人水平斜视手术中局部麻醉监护指标变化的研究

目的：观察局部麻醉监护情况下成人水平斜视手术中心电图、呼吸、血氧饱和度、血压的变化情况。

方法：临床确诊为水平斜视的17例成人患者19眼36条眼外肌纳入研究。其中男10例，女7例。年龄18～71(平均32.65)岁； 外斜视14例(男8例，女6例)，内斜视3例(男2例，女1例)。所有患者均进行最佳矫正视力(BCVA)、裂隙灯显微镜、间接检眼镜、角膜荧光及眼科同视机检查。术中由专业麻醉医师采用监护仪对手术采取全程密切监控。对比分析术前与局部麻醉监护术中的心电图、呼吸频率、血氧饱和度及血压的变化情况，对比内外直肌、不同性别及不同年龄组的区别。

结果：局部麻醉监护下17例成人水平斜视手术中牵拉眼外肌共36条，眼心反射发生率86.1%； 牵拉内、外直肌，眼心反射阳性率分别为100%，72.2%。眼心反射在男女性别间无统计学差异。18～30岁眼心反射阳性率明显高于31～71岁。术中呼吸频率的增高与眼心反射同步，与牵拉内外直肌、性别及不同年龄组无关。血氧饱和度无明显变化。血压在手术刚开始时出现一过性增高，首次牵拉眼内外直肌时出现一过性降低，在性别和年龄上无明显差异。

结论：在局部麻醉监护下成人水平斜视手术中，眼心反射发生率高，牵拉内直肌时100%发生； 呼吸增快与眼心反射同步； 手术即将开始时血压增高、牵拉眼内外直肌时血压降低。

Changes of monitoring indicators in local anesthesia in adult horizontal strabismus operation

AIM: To observe the changes of electrocardiogram(ECG), respiration, oxygen saturation and blood pressure in local anesthesia care cases in adult horizontal strabismus operation.

METHODS: Seventeen adult patients with clinical diagnosis of horizontal strabismus were enrolled to our study, including 19 eyes and 36 extraocular muscles. There were 10 males, 7 females, aged from 18- 71, with an average age of 32.65; 14 exotropia cases(8 males, 6 females), 3 esotropia cases(2 males, 1 female). All of the patients had the examination of best-corrected visual acuity(BCVA), slit-lamp microscope, indirect ophthal-moscopy, fluorescein and synoptophore. A professional anesthesiologist conducted the whole closely monitoring by using monitor during the operation. The changes of ECG, respiration, oxygen saturation and blood pressure between preoperative and intraoperative were comparatively analyzed with local anesthesia monitoring, the differences of medial and lateral rectus, different gender and different age group were compared.

RESULTS: There were 36 extraocular muscles pulled of the 17 cases adult horizontal strabismus in local anesthesia care, the incidence of oculocardiac reflex was 86.1%; pulling medial and lateral rectus, the positive rates of oculocardiac reflex were respectively 100% and 72.2%. Oculocardiac reflex had no statistical differences in different gender. The positive rates of oculocardiac reflex were significantly higher in 18-30 years than that of 31-71 years. Intraoperative respiratory frequency increased with oculocardiac reflex synchronization, but unrelated with pulling the rectus, gender and different age groups. No significant changes in oxygen saturation. Blood pressure appeared a transient increase at the beginning of the operation, a transient decrease when first pulling the rectus, there was no obvious difference in gender and age.

CONCLUSION: In local anesthesia care of adult horizontal strabismus operation, the oculocardiac reflex had a high incidence, pulling medial rectus occurred 100%; respiratory increased with oculocardiac reflex synchronization; blood pressure increased at the beginning, while decreased with pulling the rectus.