准分子激光屈光性角膜切削术后疼痛处理方法的对比观察

A COMPARISON ON PAIN TREATMENT AFTER PHOTOREFRACTIVE KERATECTOMY (PPK)

目的：探讨准分子激光屈光性角膜切削术后治疗疼痛的最佳处理方法。方法：２４０ 例近视术后患者分为４ 组，Ⅰ组０ ．１ ％ 双氯酚酸钠点眼，Ⅱ组１ ％ 潇莱威点眼，Ⅲ组双氯酚酸钠＋ 潇莱威点眼，以上３ 组必要时均口服散利痛片和安定片；Ⅳ组双氯酚酸钠＋ 潇莱威点眼，口服长效曲马多片和安定片。分别观察患者术后疼痛自主评分、手术当晚睡眠时间、服用镇痛药剂量及角膜上皮愈合时间。结果Ⅰ、Ⅱ、Ⅲ组用药后疼痛仍较明显，自主评分为５ ．９ ±０ ．７２ ，６ ．３ ±０ ．６９ ，５ ．５ ±０ ．７１ ；睡眠时间３ ．９ ±０ ．２３ ，３ ．６ ±０ ．２７ ，３ ．８ ±０ ．３１ 小时；服散利痛１ ．８５ ±０ ．７１ ， １ ．９５ ±０ ．９３ ，１ ．６５ ±０ ．６６克。Ⅳ组仅为隐痛，评分２ ．７ ±０ ．４３ ，睡眠时间６ ．７ ±０ ．２０ 小时，与前３ 组相比有显著差异（ Ｐ ＜ ０ ．０５） ，各组角膜上皮愈合时间无显著差异。结论：Ⅳ组联合用药为最佳处理方式，可供临床选用。

Objective: To evaluate the best treatment for the pain after PPK. Methods: 240 cases were divided into 4 groups after PRK: Group I was treated with 0.1% diclofenac topically, Group II 1% celluvisc topically, Group III 0.1% diclofenac+1% celluvisc topically. Tablets valium and sanlitong were given to the above 3 groups in SOS. Group Ⅳ was treated with 0.1% diclofenac+1% celluvisc topically and long acting tablets tramadol and valium. Self evaluation of pain, duration time of sleeping in the night of surgery, the dosage of analgesic and healing time of corneal epithelium were observed respeceively. Results: There were obvious pain in Groups I, II and III, the self evaluation of pain scores were estimation fraction was 5.9±0.72, 6.3±0.69, 5.6±0.71, respectively; the duration of sleeping were 3.9±0.23, 3.6±0.27 and 3.8±0.31 hours; the dosage of tablet sanlitong were 1.85±0.71, 1.95±0.93, 1.65±0.66 grams. There was only slight pain in Group Ⅳ, the self evaluation of pain score was 2.7±0.43, duration time of sleeping was 6.7±0.20 hours. No significant differences of healing time of corneal epithelium were observed among the 4 groups. Conclusions: The analgesic effect of Group Ⅳ is the best. It is valuable for clinical use.