眼后段手术局部麻醉方法的探讨

The investigation on local anesthesia method of ophthalmic operation of posterior segment

目的探讨球后麻醉联合上直肌和滑车神经麻醉在眼后段手术中的应用效果。方法眼后段手术682例（700眼）。先以传统的经皮肤球后麻醉法注射麻药1．5ml，再行上直肌麻醉，由眶上缘中部从结膜囊穹隆部进针沿眼球壁至角膜缘后约8mm上直肌止点后方，注入麻药0．5～1ml，最后行滑车神经麻醉，由眶上缘及眶内缘连接处从结膜囊进针，进针深度20mm，靠近上斜肌，注入麻药1—1．5ml。结果麻醉效果良好者685眼，占97．86％；麻醉效果欠佳者15眼，占2．14％，引起球后出血者5眼，占0．71％。结论球后麻醉联合上直肌和滑车神经麻醉可使眼球处于水平正视位，固定良好，无需牵引线。更重要的是在眼后段手术时，此种联合麻醉法疼痛感明显减轻，使眼后段手术顺利进行，并减少了麻醉的并发症。

Objective To investigate the application effect of retrobulbar anesthesia combined with superior rectus and trochlear nerve anesthesia in posterior segment ophthalmic operation. Methods Seven hundred eyes of 682 cases with posterior segment eye surgery were chosen. The traditional trans-skin retrobulbar anesthesia （ the anesthetic dose ： 1.5 ml ） was applied at first and the superior rectus muscle anesthesia （the anesthetic dose： 0. 5-1 ml） was used, and combined with the trochlear nerve block anesthesia （the anesthetic dose： 1-1.5 ml）. Then, the movement of eye was observed. Results The effect of anesthesia was good in 685 eyes accounting for 97.86% and was bad in 15 eyes accounting for 2.14%. Retrobulbar hemorrhage appeared in 5 eyes, accounting for 0.71%. Conclusion Retrobulbar anesthesia combined with superior rectus and the trochlear nerve anesthesia can make the eyeball to the horizontal position and can fix the eyeball well without the superior rectus traction suture. More importantly, this kind of combined anesthesia in the posterior segment operation reduces the pain obviously, and reduces the complications related to the anesthesia.