表面麻醉下的白内障超声乳化术

Topical anesthesia for phacoemulsification

为评估采用表面麻醉进行白内障超声乳化术的可靠性、有效性及安全性 ,对 173例白内障患者经表面麻醉进行白内障超声乳化术。随机选取同期手术的另外 173例患者采用标准的球后麻醉做为对照组。比较两组患者不同麻醉方法的并发症 ,以及两组患者术中的配合程度及疼痛感。结果 :球后麻醉组中 ,结膜水肿、结膜下出血及眼睑出血的发生率显著高于表面麻醉组 (P<0 .0 0 1) ,另有 2例发生球后出血。表面麻醉组中未见类似并发症。表面麻醉组中 16 0例 (92 .5 % )均能较好地配合手术 ,无需追加球周麻醉。仅 1例无法正常合作 ,而追加球周麻醉 ,与球后组相比无显著性差异 (P>0 .0 5 )。表面麻醉组中除 3例术中因瞳孔小 ,虹膜被意外触及时感轻度疼痛外 ,其余 170例 (98.3% )患者均无明显疼痛感。结论 :表面麻醉对于白内障超声乳化术是一种安全、有效 ,并发症少的麻醉方法。

To evaluate and compare the efficacy,liability and safety of topical and retrobulbar anesthesia for phacoemulsification,173 cataracct patients were assigned to the topical anesthesia group and 173 patients to the retrobulbar group.Phacoemulsification and intraocular lens(IOL) implant were performed in all patients in both topical and retrobulbar groups.The complications,patients cooperation and pain during surgery in both groups were compared.Results:The incidences of chemosis,subconjunctival hemorrhage and eyelid hemorrhage were significantly higher in the retrobulbar group compared with those in the topical group(P<0 001).Two patients had retrobulbar hemorrhage while having retrobulbar injections.none of these complications occurred in the topical group.160 patients(92 5%)in the topiccal group cooperated well with the surgeons during surgery.Only 1 patient was too nervous to cooperate,with a peribulbar injection supplenented(P>0 05).Only 3 patients(1 7%)in the topical group experienced minor and tolerable pain during surgery when the irises were accidentally touched(P>0 05).Conclusion:Topical anesthesia can be used safely and effectively for phacoemulsification with less fewer complications.However,pre op screening and training are the keys to the safe use of topical anesthesia.