眼底检查对极低体重早产儿系统反应影响的研究

Study on the Systemic Effects of Screening for Retinopathy in Prematurity

目的探讨对极低体重早产儿视网膜病筛查过程中使用散瞳剂、置入开睑器、使用巩膜压迫器对早产儿包括血氧饱和度、血压、脉博、呼吸、体温的影响。方法使用双目间接眼底镜进行早产儿视网膜病筛查,对其中30例<1500g的早产儿记录第一次筛查时的散瞳前5min、最后一次散瞳后15min、开睑器置入后1min、使用巩膜压迫器后1min及检查完毕后5min及15min的血氧饱和度、血压、脉搏、呼吸、体温,检查当日戴呼吸机,服用舒喘灵及使用强心剂的患儿均排除之外。结果所有早产儿脉博在散瞳前后无显著性差异,与开睑器置入、使用巩膜压迫器及检查完毕后5min、15min有显著性差异;而血氧饱和度、血压、呼吸、体温均未有明显变化。结论散瞳对早产儿无任何明显的不良影响;眼底检查时置入开睑器、使用巩膜压迫器未对早产儿造成明显的不良影响,有一过性的刺激反应。

Objective To investigate the adverse effects via vital sign changes including oxygen saturation ,blood pressure, pulse, respiratory rate, temperature during screening for the lower weight retinopatby of prematurity （ ROP）. Methods All prematurity infants fundus were examined by binocular indirect ophthalmoscope. Thirty participants weighing 〈 1500g were enrolled in this study. Oxygen sat- uration, blood pressure, pulse, respiratory rate and temperature were recorded at different time intervals during the examination, including 5min before instillations of topical mydriatics, 15rain after three instillations of topical mydriatics, l min after using of eyelid speculum, lmin after using of eye fixer, 5min after examination,15min after examination. Infants were excluded from the study if they were on the ventilator, or currently taking inotropic drugs, or had received albuterol one day before the examination. Results Pulse rate following physical manipulation of the eyes significantly varied from baseline values and the values obtained the three instillations of topical mydriat- ics,but there was no significant change between 5min before instillations of topical mydriaties and 15min after three instillations of topical mydriatics. No significant changes in oxygen saturation,blood pressure, respiratory rate, or temperature from their respective baseline val- ues were observed throughout the ROP screening examination. Conclusion Infants seem to undergo significant distress during the screen- ing for ROP using the eyelid speculum and eye fixer. Thus ophthalmologists should take into consideration the infant＇s discomfort caused by physical manipulation of the eyes and attempt to perform the examination as swiftly, softly, yet safely, as possible using topical anesthetic.