韩氏疼痛治疗仪(HANS)用于斜视矫正术镇痛的眼心反射临床研究52例

目的:观察韩氏疼痛治疗仪(HANS)在斜视矫正手术中的眼心反射(OCR)发生情况,探讨其安全性。方法:观察52例斜视手术患者,随机分为两组,各26例,治疗组采用利多卡因局部浸润麻醉,配合应用HANS超前镇痛,对照组只用利多卡因局部浸润麻醉,观察两组术中发生OCR的差异,术前、术中、术后心率的变化,并对OCR加以分层分级比较,观察两组间不良反应症状的发生情况。结果:①以心率减少值≥10%为标准,治疗组与对照组的眼心反射发生率分别为76.92%、80.77%,无显著性差异(P>0.05),总体OCR发生率为78.85%。两组间术前、术中、术后心率变化及术前与术中最低心率的差值均无显著性差异(P>0.05),两组OCR发生情况相似。②两组心率变化的自身比较,两组术前与术中、术中与术后比较均有显著性差异(P<0.01),两组对心率均有影响;术前与术后比较,治疗组无显著差异(P>0.05),对照组有显著性差异(P<0.01),提示对照组术后心率的恢复需要更长时间。③按OCR分级情况,两组OCR二级发生率无显著差异(P>0.05);一级发生率有显著性差异(P<0.01),治疗组较对照组发生率低;三级发生率有显著性差异(P<0.01),治疗组发生率较对照组为高;窦性心动过缓发生率,治疗组发生率高,有显著性差异(P<0.01)。④术中不良反应症状比较,恶心呕吐、出汗治疗组明显低于对照组,具有显著性差异(P<0.01)。结论:HANS总体上不增加OCR的发生率,术后心率恢复时间较快,可能存在双向作用,一方面,能减少OCR一级的发生率,减少不良反应的症状的发生,另一方面,对部分患者可能存在明显降低心率的作用,仍应全程心电监护。

Objective:To observe the effect on occurring of the oculocardiac reflex (OCR) and the safety with Han's Acupoint Nerve Stimulator (HANS) in surgical treatment of patients with strabismus.Methods:52 patients undergoing strabismus surgery were randomly divided into two groups ( n = 26).All patients received Local anesthesia with lidocaine,treatment group (HANS group) was also received pre-operative analgesia with HANS.The purpose of the study is to observe differences in OCR during the operation,and the changs in Heart rate(HR) respect during pre-operative,intraoperative and postoperatiive,to compare different levels and stratifications of OCR,to observe the incidence of adverse reactions between the two groups.Results:(1) To compared both groups,there was no significant difference between treatment group and Control group for the incidences of OCR (76.92%,80.77%,respectively) (P > 0.05),Overall incidence rate of OCR was 78.85% When OCR was defined as a heart rate declining by more than 10% from the initial HR.The changes of HR had no significant difference during pre-operative,intraoperative and postoperative,as well as the decline in value of the lowest HR (pre-operative HR minus minimum HR) (P > 0.05).(2) There were all significant difference when compared of the changes of their own heart rate during pre-operative and intraoperative,intraoperative and postoperative surgery in each group respectively (P < 0.01).No significant change was observed in the treatment group during preoperative and postoperative (P > 0.05),whereas in the control group there was a significant difference (P<0.01).The results suggest that the two groups may have effect on HR.while recover of heart rate in control group need more time than in HANS group.(3) It is showed no significant difference in the incidence of OCR with grade two in the two groups (P > 0.05), significant difference with gade one and grade three(P <0.01),lower with grade one,but higher with grade three in HANS groupthan in the control group.It was higher incidence of Sinus bradycardia in treatment group,there were significant differences (P <0.01).(4) Comparison of intraoperative adverse symptoms occuring rates of nausea,vomiting andsweating in treatment group was significantly lower than the control group,with significant difference (P <0.01).Conclusion:HANS does not increase totally the incidence of OCR,and it is more rapid in recovery time of heart rate after postoperative in HANS group than in control group,there may be two-way effect.On the one hand,HANS may reduce the incidence of OCR with grade one and adverse symptoms.On the other hand,for some patients,HANS may significantly Slow down the heart rate,ECG monitoring should be carried out throughout the operation.