筋膜下麻醉在后巩膜加固术中的应用研究

The application of sub-Tenon's anesthesia in posterior scleral reinforcement

目的评价筋膜下麻醉在病理性近视患者后巩膜加固术中的镇痛效果及临床应用价值。设计前瞻性病例系列。研究对象2008年12月至2010年10月北京同仁医院的病理性近视患者40例（40眼）。方法麻醉药物为2%利多卡因和0.375%盐酸罗哌卡因的1：1混合液。患者按随机数字表法分为筋膜下麻醉组（筋膜下注射麻醉药0.5~1.0 ml）和球后麻醉组（球后注射麻醉药3.0~4.0 ml）各20例,麻醉及后巩膜加固术由同一术者实施。记录所有患者术中不同疼痛程度和组织水肿程度发生的眼数,记录手术时间、手术并发症及术后不适症状,对比观察两种麻醉方法的效果。主要指标术中不同疼痛程度、组织水肿程度发生的眼数,手术时间、手术并发症及术后不适症状。结果筋膜下麻醉组和球后麻醉组术中患者疼痛程度分别为：轻度者17眼（85%）、16眼（80%）,中度者3眼（15%）、4眼（20%）,两组均无重度疼痛发生。两种麻醉组比较差异无统计学意义（P=0.681）。筋膜下麻醉组和球后麻醉组的组织水肿程度分别为：轻度者16眼（80%）、10眼（50%）,中度者4眼（20%）、7眼（35%）,重度者0眼、3眼（15%）。筋膜下麻醉组轻于球后麻醉组（P=0.033）。筋膜下麻醉组手术时间（34.70±2.70分钟）短于球后麻醉组（39.60±3.52分钟）（t=-4.946,P=0.000）;手术并发症及术后不适症状筋膜下麻醉组均少于球后麻醉组。结论筋膜下麻醉下可以顺利完成后巩膜加固术,操作简单、安全、术中并发症少,可作为后巩膜加固术的主要麻醉方法。

Objective To evaluate the analgesic effects and clinical application values of sub-Tenon＇s anesthesia for posterior scleral reinforcement in patients with pathologic myopia.Design Prospective cases series.Participants Forty cases（40 eyes） underwent posterior scleral reinforcement from December 2008 to October 2010 in Beijing Tongren Hospital.Methods Anesthetic drug was 0.375% ropivacaine-2% lidocaine 1：1 mixture.Patients were randomly divided into 2 groups,sub-Tenon＇s anesthesia group（20 eyes,0.5~1.0 ml anesthetic was injected into sub-Tenons＇ space） and retrobulbar anesthesia group（20 eyes,3.0~4.0 ml anesthetic was injected to retrobulbar space）.Anesthesia and surgery were performed by the same doctor.The number of eyes were counted according to the different levels of intraoperative pain and tissue edema,and the surgery duration,intraoperative complications and postoperative symptoms were recorded as well.The effects of two different anesthesia methods were observed.Main Outcome Measures Intraoperative pain,tissue edema,surgery duration,intraoperative complications and postoperative symptoms.Results In the sub-Tenon＇s anesthesia group,mild pain in 17 eyes（85%）,moderate in 3 eyes（15%） and severe in 0 eyes;and in the retrobulbar anesthesia group,mild pain in 16 eyes（80%）,moderate in 4 eyes（20%） and severe in 0 eyes.There was no statistically significant difference（P=0.681） in intraoperative pain between sub-Tenon＇s anesthesia group and retrobulbar anesthesia group.In the sub-Tenon＇s anesthesia group,mild edema of tissue in 16 eyes（80%）,moderate in 4 eyes（20%） and severe in 0 eyes;and in the retrobulbar anesthesia group,mild edema of tissue in 10 eyes（50%）,moderate in 7 eyes（35%） and severe in 3 eyes（15%）.Tissue edema of the sub-Tenon＇s anesthesia group was less significant than that of the retrobulbar anesthesia group（P=0.033）.Operative duration of the sub-Tenon＇s anesthesia group（34.70±2.70 minutes） was shorter than that of the retrobulbar anesthesia group（39.60±3.52 minutes）（t=-4.946;P=0.000）.Intraoperative complications and postoperative symptoms of the sub-Tenon＇s anesthesia group were less than those of the retrobulbar anesthesia group.Conclusions Sub-Tenon＇s anesthesia can contribute to the success of posterior scleral reinforcement surgery.It is safe and simple to operate with few intraoperative complications.It should be an alternative anesthesia for posterior scleral reinforcement surgery.