精神病患者白内障手术的麻醉处理

Anesthesia in cataract surgery for patients with psychosis

目的探讨丙泊酚在精神病患者白内障手术麻醉中的应用。方法 2006年6月至2012年7月行白内障手术的精神病患者15例(18眼),入手术室后立即给予鼻导管吸氧,建立静脉通路,连续监测ECG、HR、BP、SpO2、PetCO2、BIS。丙泊酚1～2 mg/kg微量泵静脉注射,当BIS值在60以下时开始手术。术中丙泊酚2～5 mg/(kg.h)持续微量泵静脉注射维持麻醉,因疼痛体动者静脉注射芬太尼20～50μg,BIS值维持在40～60。手术结束停止泵注丙泊酚。结果 15例患者均顺利完成手术。其中2例出现一过性呼吸抑制,SpO2在正常范围,减少丙泊酚用量后好转,未予特殊处理。余13例均未出现麻醉相关并发症。术后随访未发现麻醉后遗症或精神病病情加重。结论丙泊酚可以满足精神病患者白内障手术的需求;同时要做好术前访视、术中监护及术后管理工作,使患者安全度过围手术期。

Objective To evaluate the effect of propofol in cataract surgery anesthesia for mental illness. Methods We investigate 15 psychiatric patients who underwent cataract surgery from June 2006 to July 2012. In operating room, oxygen inhalation was given through nasal catheter and intravenous access was established. ECG, HR, BP, SpO2, PetCO2 and BIS were continuously monitored. 1-2mg/kg propofol was injected and the BIS value was kept below 60 before operation. Anesthesia was maintained by 2-5mg/（kg·h） propofol microinjection, and additional 20-50μg fentanyl was given in case of body movement in response to pain. BIS value was maintained at 40 to 60 during the operation, and propfol pumping was stopped at the end of surgery. Results All operations were successfully performed. Only two cases had transient respiratory depression, but their SpO2 was normal. The situation was improved after reducing the speed of propofol pumping, and no special treatment was given. No anesthesia-related complications happened in remaining cases. No anesthetic sequelae or psychotic exacerbations were found during postoperative follow-up. Conclusion Propofol can be used in psychiatric patients’ anesthesia for cataract surgery. At the same time, preoperative visit, intraoperative monitoring, and postoperative management and nursing should be enhanced in order to ensure safety of psychosis patients during perioperative period.