球后麻醉在非定量斜视手术中的应用

Application of retrobulbar anesthesia in nonquantitative strabismus surgery

目的探讨球后麻醉在非定量斜视手术中的有效性和安全性。方法前瞻性病例对照研究。患者85例（101眼），男50例，女35例，平均年龄24．8（11-59）岁，均为行斜肌手术或直肌移植术，术前手术方式已确定，无需术中调整的患者。将患者随机分为球后麻醉组（50例，61眼）及对照组（浸润麻醉；35例．40眼），采用1％利多卡因与0．75％布比卡因3：1混合分别对患者行球后麻醉或浸润麻醉后．行下斜肌部分切除术、下斜肌前转位术、下斜肌探查术、上斜肌断腱术及直肌移植术等术式，术巾、术后第1天询问患者有无疼痛及不适等症状，采用口述描绘评分法（VRS）对其疼痛程度进行评估，并观察手术效果。两组数据的比较采用X^2检验。结果球后麻醉组患者术中对疼痛的耐受性良好，无严重全身及局部并发症的出现，VRS评分均为0级（54％）和1级（46％），与对照组比较，差异有显著统计学意义（X^2=13．833，P〈0．01）。斜肌亢进消失率或直肌移植成功率均达100％。结论在球后麻醉下进行非定量斜视手术切实可行，适用于配合程度良好的大龄儿童及成人患者。

Objective To study the efficacy of retrobulbar anesthesia in nonquantitative strabismus surgery. Methods A prospective, case-control study was performed on 85 patients who were presented for nonquantitative strabismus surgery. Retrobulbar anesthesia （61 eyes of 50 cases） and local infiltration anesthesia （40 eyes of 35 cases） was performed before operation respectively. Intraoperative and postoperative pain was assessed by using verbal rating scales, and anesthesia efficiency and operation efficiency were recorded. Data were analyzed withX^2 test. Results Operation was well tolerated with no complication in patients with retrobulbar anesthesia. 54% patients showed no pain and 46% patients showed mild pain according to verbal rating scales, and this was significantly better than that of the control group （X^2=13.833, P〈0.01）. The success rate of surgery was 100%. Conclusion Retrobulbar anesthesia proves to be an efficient and safe procedure for nonquantitative strabismus surgery.