术中唤醒用于全麻下斜视矫正手术70例

General anesthesia with intra-operative wake-up test in strabismus surgery in 70 patients

目的探讨全麻术中唤醒用于青少年斜视矫正术调整眼位的可行性。方法将136例斜视分为全麻术中唤醒组和全麻无术中唤醒组两组。术中唤醒组的患者在全身麻醉下行斜视矫正术,手术中缝合固定肌肉时先打活结,保留缝线,唤醒后检查眼位,若眼位正位,将缝线活结结扎;若欠矫或过矫则再次麻醉,调整缝线,直至眼位正位。无术中唤醒组的患者使用氯胺酮进行全麻,按照术前设计的手术方式常规手术。结果①术中唤醒组70例患者中,65例唤醒后检查眼位正位,或略加调整缝线松紧度即可达到正位,5例唤醒后观察眼位欠矫或过矫,经过再次全麻-矫正-再唤醒的过程达到满意;②术后1周,术中唤醒组手术成功率为100%,无唤醒组手术成功率为92.4%,两组间比较χ2=5.505,P=0.019,差异有统计学意义;术后1年随访术中唤醒组手术成功率为93.7%,无术中唤醒组手术成功率为87.1%,两组间比较χ2=1.547,P=0.214,差异无统计学意义。结论全麻术中唤醒用于斜视矫正手术可以减轻患者的痛苦,并且可以在手术过程中调整眼位,从而提高斜视手术的矫正效果,为青少年斜视矫正手术的研究提供经验。

Objective To evaluate the feasibility and efficiency of the intraoperative wake-up test for strabismus surgery in teenagers. Methods All 136 cases underwent general anesthesia and were divided into 2 groups. The first group had general anesthesia with intra-operative wake-up test,and the other had general anesthesia without the test. In the first group,operated muscles were first tightened with a slipknot. Then,the patient was awakened to examine the eye position. If the position was orthoptic,the suture was securely tied. Otherwise,general anesthesia was reinstalled and the surgical procedures were repeated until the orthoptic position was achieved. The other group underwent surgery under general anesthesia with ketamine according to the preoperative assessment. Results （1）70 cases received intraoperative wake-up test. Among them,65 reached orthoptic position when awakened while the procedures were repeated again in the other 5 cases to achieve the goal. （2）The success rate of the group with intra-operative wake-up test was 100% 1 week after the operation,which was significantly higher than the other group （92.4%,P=0.019）. One year after the operation,the success rates of surgery in patients with and without intra-operative wake-up test were 93.7% and 87.1%,respectively. There was no significant difference among the two groups （P=0.214）. Conclusion General anesthesia with intra-operative wake-up test not only alleviates the pain of teenager in strabismus surgery,but also improvesthe success rate.