眼部美容外科手术中的眼心反射

Oculo-cardiac reflex during ocular plasty

目的 通过眼部美容外科手术观察眼心反射 ,并探讨其可能的发生机制。方法 对 132例眼部美容外科手术者 (其中切开法重睑成形术 4 8例 ,埋线法重睑成形术 2 2例 ,上睑下垂矫正术 13例 ,上睑倒睫矫正术 7例 ,下睑袋修复术 4 2例 ) ,术中进行动态心电图监测 ,分析比较术前、术中心率的变化。结果 眼心反射阳性标准为心率较术前每分钟减慢 10次以上。所有受术者中 ,共 4 1例出现眼心反射 ,6例均出现 2次 ,共发生 4 7次。包括注射局麻后即发生有 10次 ,牵拉眼睑、眼轮匝肌及上睑提肌时出现 9次 ,分离眶隔 ,提拉眶隔脂肪剪除时发生 2 1次 ,术后用纱布压迫眼球时出现 7次。眼心反射发生率为31.1%。结论 眼部美容外科手术中眼心反射是由于术中牵拉眼外肌、压迫眼球和提拉眼睑等组织所引起 ,可致心率减慢、心脏节律和呼吸的改变 ,甚至引起心跳骤停。所以手术应轻柔、准确、快捷 ,避免因牵拉眼外肌压迫止血而过多过重地压迫眼球 ,或眶内加压 ,以减少眼心反射的发生。

Objective To observe the oculocardiac reflex during the ocular plasty and to study its possible mechanism. Methods A total of 132 cases were studied by dynamic electrocardiography to analyze the changing of heart rate before and after operations. Results Heart rate decreasing by over 10 times during operations was regarded as the positive standard of the oculocardiac reflex. Of all cases the oculocardiac reflex appeared in 41 cases and 53 times were observed including of continual two times happened in 6 cases. In all the reflex ,9 cases was observed in injection of anaesthetic, 5 cases in pulling eyelids, the orbicular muscle and the palpabralis muscle, 21 cases in resecting orbital fats,6 cases in stressing the eyeball after operations. The incidence of oculocardiac reflex was 31.1%. Conclusion Some steps in the process in ocular plasty are more possible to elicit the reflex, such as dragging peripheral eyeball muscles,stressing eyeball and pulling eyelid. The reflex will result in heart rate decreasing, heart rhythm and respiratory changing,even render heart to sudden stop . Therefore, we should operate gentlely and accurately,and also avoid overly stress on eyeball to elicit the oculocardiac reflex.