前房麻醉在合并糖尿病白内障超声乳化中的应用

Intracameral anesthesia in phacoemulsification cataract patients with diabetes

目的探讨合并糖尿病的白内障超声乳化术中应用前房麻醉其稳定前房、散瞳及麻醉效果。方法收集2007年2月至2008年1月就诊的糖尿病性白内障患者，随机分成两组，观察组20例（23只眼），给予爱尔凯因表麻联合1％的不含防腐剂的利多卡因前房麻醉，对照组20例（22只眼）给予单纯表面麻醉。全部患者均行晶状体超声乳化吸出联合人工晶状体植入手术，分析其麻醉效果及前房稳定情况。乳化后和术毕时瞳孔较术前的缩小值，术后瞳孔对光反应、术后1月较术前角膜内皮细胞的减少值，并观察手术并发症的发生隋况。结果麻醉效果两组间差异有统计学意义（P〈0．05）。乳化后及术毕时瞳孔较术前的缩小值组间差异有统计学意义（P〈0．05）。观察组术中前房稳定性较好，平均乳化时间48．3s，对照组乳化时间平均57．6s。术后瞳孔对光反应、术后1月较术前角膜内皮细胞的减少值组间差异无统计学意义，两组术后角膜水肿、房闪、前房纤维素性渗出等并发症组间差异无显著性。结论合并糖尿病的白内障在超声乳化术中应用前房麻醉可散大并稳定术中瞳孔大小，增加麻醉效果和前房稳定性，利于手术操作，提高手术成功率，是安全、有效。

Objective To investigate the application of intracameral anesthesia in phacoemulsification in the cataract patients with diabetes and to obverse anterior stability, the effect ofmydriatis and the efficacy of anesthesia.Methods Patients of cataract with diabetes were collected from February, 2007 to January 2008.Patients were randomly divided into 2 groups.The observation group （20 cases, 23 eyes） received topical anesthesia with aiercain plus intracameral injection of 1% nopreservative lidocain 0.5ml.The control group （20cases, 22 eyes） received topical anesthesia.All patients underwent phacoemulsification combined with introcular lens implantation through clear cornea incision.The efficacy of anesthesia and anterior stability were analyzed.Pupil diameters were recorded.Diminution of pupils after emulsification and surgery were calculated. The light reflex postoperative, corneal endothelial cell loss in 1 month postoperative and the surgical complication were observed.Results The efficacy of anesthesia and diminution of pupils after emulsification and surgery was significantly different between the two groups （P〈0.05）.The anterior stability during the operation is better in the observation group especially when emulsification top entered anterior chamber, filling initiated and IOP stepped up.Average emulsify time was 48.3 s in the observation group, while the average time was 57.6 s in the control group.There was no significantly difference between two groups＇ subjective in the light reflex postoperative, corneal endothelial cell loss and surgical complications, such as postoperative corneal swelling, inflammatory reaction, and anterior exudation.Three samples in the control group had iris depig-menting.None occurred hyphema, margo pupillaris bitten, posterior capsular fracture and prolapsus vitrei as surgery proceeded.There was not any serious complications such as cornea decompensation, shallow of anteri- or chamber, retinal detachment in all cases.No adverse reaction of system happened to observation group.Conclusions Intracameral anesthesia in phacoemulsification cataract patients with diabetes can mydriasis and stabilize pupils size.To increase anaesthesia result and the stability of anterior, which is benefit for surgical op- eration, lessen bulbus＇ automatic, the difficulty of emulsification, emulsification time, energy damage and raise the operation achievement ratio.It can not harm corneal endothelium, increase inflammatory reaction and adverse reaction of system.It is a safe, effective, feasible method.