监护麻醉管理在眼科玻璃体视网膜手术中的应用

The application of monitored anesthesia care(MAC) in vitreoretinal surgery

目的探讨监护麻醉管理(MAC)在眼科玻璃体视网膜手术中的应用。方法 60例美国麻醉师协会(ASA)分级Ⅰ、Ⅱ级眼科玻璃体视网膜手术患者使用咪达唑仑、芬太尼、丙泊酚行MAC,术中所有患者中常规作血氧饱和度(SpO2)、呼吸、无创血压和心电图监测,行镇静深度评分,工具为睡眠障碍镇静评分标准(Ramsay评分);记录SpO2<90%超过30 s、呼吸频率(RR)<8 bpm超过60 s、血压(BP)<80/50 mmHg、心率(HR)<50 bpm的发生率以及术中的体动反应,观察围麻醉期恶心、呕吐发生率,术后患者满意度评估。结果 MAC过程中BP平稳,HR<50 bpm超过30s发生率为1.7%(1/60),RR低于8 bpm超过60 s的发生率为3.3%(2/60),SpO2<90%超过30 s的发生率为5%(3/60),6例术中发生呻吟体动反应,2例女性患者术后有恶心无呕吐,术后满意度评分为(2.4±0.6)分。结论以咪达唑仑、芬太尼、丙泊酚行MAC可安全有效地应用于眼科玻璃体视网膜手术中,解除患者恐惧焦虑,减轻疼痛及其他伤害性刺激,患者满意度高。

Objective To evaluate the application of monitored anesthesia care（MAC） in vitreoretinal surgery.Methods Monitored anesthesia care（MAC） with midazolam,fentanyl and propofol was performed in 60 ASA Ⅰor Ⅱ patients in vitreoretinal surgery.With regular monitoring of SpO2,RR,BP and ECG,sedation depth was made in accordance with Ramsay scores by the incidence of RR 8 bpm lasting over 60 sec or SpO2 90% lasting over 30 sec or HR50 bpm or body movement response.Postoperative symptoms as nausea and vomiting in patients were recorded and their satisfaction after surgery was also assessed.Results During MAC management procedure,BP remained stable,the incidence rates of HR50 bpm,RR 8 bpm lasting over 60 sec and SpO2 90% lasting over 30 sec were 1.7%（1/60）,3.3%（2/60） and 5%（3/60） respectively.Body movement occurred in 6 patients during the process of surgery,and 2 female patients had symptoms of postoperative nausea and vomiting.Postoperative satisfaction scores were（2.4±0.6） min.Conclusion MAC with midazolam,fentanyl and propofol can be safely and effectively used in vitreoretinal surgery with high satisfaction of patients by lightening or relieving anxiety and fearful pain and other nociceptive stimulus in patients.