全麻下儿童斜视矫正手术的术期观察和护理

斜视是儿童的常见眼病,早期发现与早期矫正眼位非常重要.斜视矫正手术不仅可使患儿有望获得双眼单视功能,而且对其外观的改善及身心的健康成长起到重要的促进作用.全麻下儿童斜视矫正手术的顺利实施依赖于护士严密的观察及护理,术中患儿会出现多种护理问题,如手术安全核查、麻醉的护理配合、眼心反射的观察与处理、静脉补液问题等等.回顾我院手术室2010年7月至2011年8月完成的128例全麻下儿童斜视矫正手术的术期观察和护理,报告如下.1资料和方法1.1一般资料128例中男56例、女72例,年龄1～8.5岁,平均(5.5±0.72)岁.单眼38例,双眼90例.手术方法全角直肌后徙、缩短术,下斜肌切断+部分切除术,上斜肌断腱肌止端移位术.手术历时6～30min.均顺利度过手术期,无护理并发症发生,术后安全返回病房.     

共同性斜视围手术期护理

目的 探讨共同性斜视围手术期的护理方法.方法 对45例共同性斜视患者围手术期运用护理程序进行护理.结果 通过对共同性斜视患者围手术期的精心护理,患者眼位偏斜得到满意的矫正,复视症状消失,无明显并发症.结论 通过对共同性斜视患者有针对性的心理护理,克服了心理障碍,安抚了不安情绪,以健康心态接受治疗,并有利于减轻斜视术后眼部不适及胃肠道症状,心理护理和术后眼部护理对患者的治疗、顺利康复同等重要.     

双外直肌后徒治疗儿童间歇性外斜视

目的：探讨双外直肌后徒治疗儿童间歇性外斜。方法：对16例接受双外直肌后徒的间歇性外斜视儿童进行临床观察分析。记录第一次手术的年龄,屈光度,斜视度和术后6月的眼位。结果：随访末12例（75％）眼位矫正,欠矫和过矫各2例（12．5％）,5例（31．25％）,接受第二次手术,1例出现单眼固视综合征。结论：双外直肌后徒术可使大多数间歇性外斜儿童猁眼位矫正;但手术年龄,术前斜视度和屈光度不预示手术的成功,与兴6个月时的眼位相关。     

手术显微镜下斜视矫正手术的临床疗效

目的 探讨手术显微镜下斜视矫正手术的可行性和并发症的发生情况.方法 128例斜视随机分为两组,手术显微镜下斜视矫正手术70例为试验组,肉眼直视下传统斜视矫正手术58例为对照组.术后随访时间6 ～12个月,平均(8.20±2.41)月,观察患者眼位矫正情况及结膜切口瘢痕、肌肉缝线反应、结膜下囊肿、术后感染、眼前段缺血综合征等并发症发生情况.结果 试验组眼位矫正有效率97.14％,对照组眼位矫正有效率96.55％,两组眼位矫正效果对比,差异无统计学意义(x2=0.04,P＞0.05).试验组并发症发生率1.43％,对照组并发症发生率10.34％,两组差异有统计学意义(x2=4.88,P＜0.05).结论 手术显微镜下斜视矫正手术是可行的,具有与传统斜视矫正手术相同的效果,显微斜视矫正手术具有术后反应轻、并发症少等明显优势.     

改良穹隆结膜小切口技术在儿童水平斜视中的应用

目的　应用Guyton斜视钩进行改良穹隆结膜小切口斜视手术,观察其在儿童水平斜视中的临床效果。方法　回顾性分析2014年1月至2017年6月在我院行水平斜视患儿128例（170眼）,年龄1.5～17.0（6.5±1.6）岁,男60例,女68例。应用Guyton斜视钩行改良穹隆结膜小切口手术,术后随访6~12个月,观察手术矫正效果、结膜切口干预情况、术后恢复情况及并发症情况等。结果　119例（93.0%）在第一眼位获得理想眼位,矫正后斜视角度＜±10。102眼（60.0％）未行切口缝合;68眼（40.0%）进行结膜切口干预,其中缝合1针者45眼（26.5%）,缝合2针者20眼（11.8%）,缝合3针者3眼（1.8％）。术后眼部刺激症状轻,结膜切口愈合佳,无明显手术瘢痕。结论　在儿童水平斜视中,应用Guyton斜视钩的改良穹隆结膜小切口技术是安全有效的方法,术中、术后并发症少,疗效确切,美容效果满意。     

垂直斜视手术治疗的研讨

目的：观察垂直斜视手术治疗方法的可行性。方法：1．对每一眼位无垂直斜视或垂直斜角小于10^△且合并有下斜肌亢进者，行单侧或双侧下斜肌减弱术；2．手术一般选择在高位眼、非注视眼和麻痹眼上进行；3．对单侧或双侧上斜肌麻痹患者如第一眼位垂直斜视角在大于15^△至35^△之间时，只有在对侧眼无上转受限，才可在一眼上行双上转肌减弱术；4．垂直斜视合并大角度水平斜视者手术应分次做，第一次在手术矫正水平斜视时同时做不定量的下斜肌手术。结果：29例获得双眼正位，其中11例获得功能治愈；未获得矫正的2例，1例为垂直斜视合并内斜，术后近期正位，6周随访时仍内斜15^△并出现头位，另1例术后2周仍下斜视10^△一15^△。结论：上述手术方法对治疗垂直斜视是可行的。     

儿童斜视矫正术后的立体视觉

本文报告１６８例儿童斜视术后有６０例获得立体视觉，功能治愈率达３５．７％。结果表明：斜视儿童术后立体视恢复与手术年龄、斜视度大小和术后眼位矫正程度等因素密切相关（Ｐ＜０．０１）。作者认为，手术时机的最佳选择取决于斜视类型和儿童初诊年龄。手术正位率是立体视重建和恢复的必不可少的因素。     

儿童斜视手术与恶性高热

目的：探讨儿童斜视手术出现恶性高热的可能、诊断和急救处理。方法回顾和分析1例儿童斜视全麻手术后突发高热的诊断和救治过程。结果该例患者经及时有效降温等对症治疗后,治愈出院。结论儿童全麻下行斜视矫正术应警惕恶性高热,手术时及术前、术后应有相应防范措施以及应对准备。     

成人斜视手术疗效观察

目的 了解成人共同性斜视矫正术后，眼位及视功能恢复情况。方法 将我院2003-2004年手术矫正大龄共同性斜视114例患者进行分析，其中男58例，女56例。年龄17～54岁，平均24．5岁。共同性内斜视28例，共同性外斜视86例。屈光不正85例，弱视52例。斜视角〈50^△者27例，≥50^△87例。术后早期进行视功能训练7-10次。术后观察1～16个月。结果 眼位矫正满意，正位98例，占85．94％，欠矫15例，外观满意未行二次手术，过矫者1例，配压贴三棱镜矫正。术后经过训练恢复视功能者14例，占12．28％。结论 成人斜视手术主要是美容矫正，视功能很难恢复。故弱视、斜视应早期治疗。有手术指征者应及时手术。     

PRK治疗屈光性斜视的临床效果分析

目的：评价角膜屈光手术治疗屈光性斜视的临床效果。方法：对43例（77眼）近视及近视散光并伴有不同程度的斜视的病例进行PRK治疗，术后辅以遮盖疗法等非手术治疗训练，观察术前后斜视的变化。结果：术后在视力得到充分矫正的同时，斜视也得到了改善及消除。结论：角膜屈光手术治疗屈光性斜视是一种有效的方法。     

直肌后徙可调缝线术在儿童共同性斜视中的应用

目的：观察直肌后徙可调整缝线术治疗儿童共同性斜视的临床效果。方法对34例儿童共同性斜视在全麻下采用直肌后徙调整缝线术治疗,术后1～2 d内进行缝线调整,随访6～24个月,观察手术效果。结果34例儿童共同性斜视患者中,11例达正常眼位,23例因欠矫或过矫需要调整,其中过矫9例及欠矫11例均调至正位,有3例欠矫者经集合训练后得到改善。在6～24个月随访中,未调整的患者中欠矫1例,经过调整的患者中欠矫2例,术后视功能较术前有明显的改善。结论采用可调整缝线治疗儿童共同性斜视是简便而有效的手术方式,可以减少再次手术风险,使儿童全麻斜视矫正手术的成功率获得较大的提高。     

Using diazepam and atropine before strabismus surgery to prevent postoperative nausea and vomiting: a randomized, controlled study.

OBJECTIVE: To evaluate the efficacy of diazepam and atropine sulfate premedication in preventing nausea and vomiting after strabismus surgery under general anesthesia. METHODS: Fifty children age 4 to 15 years who underwent strabismus surgery at Cukurova University Medical Faculty, Department of Ophthalmology, from February 2000 to June 2000 were randomized into 2 groups: 25 children in the control group did not receive premedication, whereas 25 children in the treatment group received premedication with 0.15 mg/kg diazepam and 0.015 mg/kg atropine sulfate. Occurrence of postoperative nausea and vomiting (PONV) was recorded. RESULTS: The incidence of PONV was lower in the premedicated group (P <.018, chi(2) test). CONCLUSIONS: It is concluded that diazepam and atropine sulfate premedication decreases nausea and vomiting after strabismus surgery.     

Successful implementation of a protocol for photorefractive keratectomy in children requiring anesthesia

PURPOSE: To describe a protocol for treating children with photorefractive keratectomy (PRK) under general anesthesia and to review intraoperative and postoperative complications. SETTING: Institutional academic practice. METHODS: Nine patients between 3 years and 9 years of age were treated with PRK under general anesthesia for anisometropia with unilateral high myopia or high hyperopia and amblyopia of the affected eye. Induction of anesthesia and the surgical procedure were carried out in separate rooms. The laser beam was centered on the entrance pupil, and eye position was monitored throughout the procedure. Specific precautions were taken before and during the procedure to prevent unwanted effects of inhalational anesthetic agents on laser performance. RESULTS: All children did well, with no anesthesia-related or treatment-related complications. CONCLUSIONS: Our protocol for PRK under general anesthesia was effective and efficient in children who were unable to cooperate for the procedure using local anesthesia. It can be adapted for laser in situ keratomileusis and other refractive surgical procedures in children and uncooperative adults.     

显微镜下斜视矫正术

目的:观察采用普通显微器械显微镜下斜视矫正术的可行性。方法:把斜视病例分为两组:显微镜下斜视矫正术组:36例各类斜视患者,均采用显微技术在显微镜下行斜视矫正术。直视下斜视矫正术组:45例,直视下行斜视矫正术。结果:追踪观察2wk~6mo,显微镜下斜视矫正术组:术后反应轻,结膜水肿、充血消褪较快,伤口愈合好,无1例并发症发生。直视下斜视矫正术组:术后发生肌肉滑脱的2例,球结膜伤口充血、结膜下出血、水肿者40例,结膜瘢痕10例,结膜囊肿2例,结膜息肉3例。结论:显微镜下斜视矫正术较传统直视下斜视矫正术具有较明显优势,可以清晰地看清肌肉、血管、及针在巩膜内的走行、深浅,使手术较易掌控,可以使手术量及手术操作准确无误,缩短手术时间、避免出血、穿透巩膜等直视下手术常见的并发症的发生,同时组织分离准确,操作减少,也直接减轻了术后反应,缩短了术后恢复时间,适合所有需斜视手术患者,优势为初学者易掌握巩膜进针深度。     

不同局部麻醉方式下斜视手术疗效的分析

目的:探讨青少年与成年人在两种不同麻醉方法后的斜视手术治疗效果及对患者心理健康的影响。方法:回顾性分析我科2004-01/2008-04在单纯局部麻醉后行斜视手术146例及2008-07/2011-07在局部麻醉联合神经安定后行斜视手术90例患者的疗效比较。结果:单纯局部麻醉后斜视手术146例,术后眼位矫正134例,欠矫10例,二次手术2例,无1例过矫;局部麻醉联合神经安定后斜视手术90例,术后眼位矫正85例,欠矫5例,无1例二次手术。结论:在局部麻醉联合神经安定后进行斜视矫正术可减少患者术中因精神紧张及疼痛所致的眼位表现异常,从而减少二次手术的几率,明显提高手术治愈率。     

Strabismus after regional anesthesia for cataract surgery

BACKGROUND: An adult strabismus clinic in a regional eye centre provided an opportunity to estimate the risk of postoperative diplopia from regional anesthesia after cataract surgery and to describe the management of these patients. METHODS: Retrospective cohort analysis. All cases were referred over a 22-month period (November 1997 to September 1999) for investigation of postoperative diplopia after cataract surgery. The surgical and anesthetic records were reviewed to determine the number and location of injections, and the volume and type of regional anesthesia. The evolution and management of patients' diplopia was studied prospectively. RESULTS: Twenty-one patients (12 women and 9 men aged 63 to 88 [median 76] years) were ascertained with postoperative diplopia. In 11 cases the right eye was affected, and in 10 cases, the left eye. Vertical diplopia occurred most commonly from inferior rectus restriction (16 cases). Three cases resolved without treatment, which indicated that the diplopia was transient. Four patients declined treatment, five required prism in eyeglasses only, and nine required strabismus surgery. One patient required surgery and prism in eyeglasses. Two patients required more than one strabismus operation to relieve the diplopia. For the period of data collection, we estimate the risk of nontransient postoperative diplopia from regional anesthesia as 2.6 cases per 1000 cataract procedures (95% confidence interval 1.9-4.7). INTERPRETATION: Patients should be forewarned of the risk of diplopia after cataract surgery with regional anesthesia. The treatment of the diplopia may require prism in eyeglasses or strabismus surgery or both.     

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.     

Single-stage adjustable strabismus surgery under topical anesthesia and propofol

AIM: To present our experience with single-stage adjustable strabismus surgery (SSASS) under topical anesthesia and propofol. MATERIALS AND METHODS: Sixteen patients who either had diplopia before the surgery or were at risk of developing diplopia after the surgery were selected for this operation after evaluating their tolerance for an eyelid speculum. Recession of the lateral recti, recession, resection and advancement of the medial recti, anteriorization of the inferior oblique and marginal myotomy to the superior rectus were the procedures done under topical anesthesia and propofol. The operations were done in two phases; in the first phase, the patients were sedated for 10 minutes with intravenous propofol (2 mg/kg) and the operation was done under topical anesthesia with 2% lidocaine. In the second phase, the patients were conscious and the adjustments were made. RESULTS: None of the patients complained of significant pain during the surgery. No complications occurred during and after the procedure and no patients had diplopia during the postoperative follow-up. CONCLUSIONS: Single-stage adjustable surgery is practical and avoids the risks of regional and general anesthesia. The only disadvantage is the pain that some patients experience. We found that it is feasible to use propofol for this surgery; it provides deep sedation and prevents pain from being felt during the operation, and its short elimination half-life provides rapid awakening for the adjustment phase.     

复杂性斜视手术显微镜下眼外肌调整缝线式手术的效果

目的:观察手术显微镜下眼外肌调整缝线式手术治疗复杂性斜视的效果。方法:回顾性分析郑州市第二人民医院2015年1月至2018年12月就诊的191例复杂性斜视的临床资料。所有患者均在全麻下行手术显微镜下眼外肌调整缝线手术矫正斜视,其中83例为超长量手术。全麻苏醒后或次日观察眼位及有无复视或复视是否消失,如需调整缝线则在局麻或全麻下进行调整。随访观察6个月。结果:术后全部眼位矫正良好、复视消失,未出现肌肉滑脱等并发症。结论:对复杂性斜视行手术显微镜下眼外肌调整缝线斜视矫正术,手术成功率较高,手术反应少。     

Single-Stage Adjustable Strabismus Surgery under Topical Anesthesia and Propofol

Aim: To present our experience with single-stage adjustable strabismus surgery (SSASS) under topical anesthesia and propofol. Materials and Methods: Sixteen patients who either had diplopia before the surgery or were at risk of developing diplopia after the surgery were selected for this operation after evaluating their tolerance for an eyelid speculum. Recession of the lateral recti, recession, resection and advancement of the medial recti, anteriorization of the inferior oblique and marginal myotomy to the superior rectus were the procedures done under topical anesthesia and propofol. The operations were done in two phases; in the first phase, the patients were sedated for 10 minutes with intravenous propofol (2 mg/kg) and the operation was done under topical anesthesia with 2% lidocaine. In the second phase, the patients were conscious and the adjustments were made. Results: None of the patients complained of significant pain during the surgery. No complications occurred during and after the procedure and no patients had diplopia during the postoperative follow-up. Conclusions: Single-stage adjustable surgery is practical and avoids the risks of regional and general anesthesia. The only disadvantage is the pain that some patients experience. We found that it is feasible to use propofol for this surgery; it provides deep sedation and prevents pain from being felt during the operation, and its short elimination half-life provides rapid awakening for the adjustment phase.