病人自控镇静镇痛在玻璃体和斜视手术的应用研究

 [目的]探讨病人自控镇静镇痛（PCSA）在玻璃体和斜视手术中应用。[方法]玻璃体切割术和斜视矫正术病人共68例,随机分入舒芬太尼联合异丙酚PCSA组（P组）和单纯局麻组（C组）。每组34例,其中两类手术各占17例。P组局麻并以PCSA辅助。术中观察收缩压、心率、呼吸、镇静评分、病人合作度评分、满意度评分、疼痛评分及术中眼心反射和术后恶心呕吐等不良反应。[结果]与基础值比较,P组仅术中10min的收缩压、心率升高;C组术中各时点均显著升高;P组呼吸频率下降。术中P组镇静评分、合作度和满意度评分显著高于C组,而疼痛评分、躁动、呻吟发生率显著低于C组。两组眼心反射和恶心呕吐发生率无差异。术后4h疼痛评分P组显著低于C组,术后8h两组疼痛评分无差异。[结论]舒芬太尼联合异丙酚PCSA应用于玻璃体及斜视手术能提高病人术中术后镇痛的满意度,安全有效。

Patient-controlled Sedation Analgesia during Vitreous and Strabismus Surgery

Objective To compare the safety and effectiveness of patient-controlled sedation and analgesia with topical anesthesia during vitreous and strabismus surgery. Methods A total of 68 patients scheduled for vitreous and strabismus surgery were randomly divided into two groups: patient-controlled sedation and analgesia (group P,n=34) and control group(group C,n=34). 17 patients with vitreous surgery and 17 patients with strabismus surgery were included in each group. PCSA and topical anesthesia were applied in group P. Systolic blood pressure(SBP),heart rate (HR),respiratory rate (RR),Ramsay's score,cooperation score,satisfactory score,visual pain score(VAS) and side-effects such as intraocular pressure,nausea,and vomiting were measured. Results In group P,SBP and HR rose 10 min after the beginning of the operation,then dropped to baseline value and respiratory rate decrease at the same time. In group C,SBP and HR rose during the procedure of the operation. Ramsay's score,cooperation score,satisfactory score of the patients in group P were higher than those in group C. VAS score,agitation,and groan incidence were higher in C group than those of in group P. There were no difference of intraocular pressure,nausea,and vomiting between the two groups. The VAS score in group P was lower than that in group C surgery after 4 h,there was no difference between two groups surgery after 8 h. Conclusion Patient-controlled sedation analgesia with a combination of sufentanil and propofol,which increases the satisfactory score of the patients during the operation and after the operation,is a safe and effective method for vitreous and strabismus surgery.