局部麻醉或辅助地西泮在斜视矫正术中的作用

Local anesthesia or auxiliary diazepam in strabismus surgery

目的 应用面部表情分级评分（face rating scale,FRS）、焦虑评分（self-rating anxiety scale,SAS）,观察共同性斜视矫正术患者应用局部麻醉及麻醉前应用地西泮注射液的效果,比较手术前、后的疼痛情况、焦虑、术中牵拉不适及术后随访情况。方法 对2012年8月至2014年8月在我院住院的眼科共同性斜视患者88例（108眼）,年龄11∽40岁,进行显微镜下斜视矫正术,采用随机、对照、双盲的研究方法,随机分为两组：对照组44例54眼（局部注射盐酸罗哌卡因注射液）,用药组44例54眼术前辅助肌肉注射地西泮注射液0.2 m L·mg-1。记录术中、术后1 h的FRS、SAS,同时记录术中患者手术时间、牵拉反射及随访情况。结果 用药组与对照组患者术中、术后FRS差异均有统计学意义（均为P〈0.05）。用药组与对照组患者SAS评分术中、术后差异均有统计学意义（均为P〈0.05）。用药组手术时间较对照组缩短（均为P〈0.05）;用药组患者牵拉反射不适减轻,与对照组差异有统计学意义（P〈0.05）,同时用药组患者手术中生命体征平稳,更好配合医师手术。结论 局部麻醉手术辅助术前应用抗焦虑、镇静药物行斜视矫正术具有较好的镇痛效果;明显缓解因术中精神紧张、疼痛及恶心等所致眼位异常,提高手术舒适度、减轻术后不适感,术中医师操作顺利、术后眼位复位较好。

Objective To evaluate the effects of diazepam injection on preopera- tive and postoperative anxiety, soreness, dragging reflection and follow-up for concomitant strabismus surgery administrated before local anesthesia by using face rating scale （FRS） ,self-rating anxiety scale（SAS）. Methods A total of 88 concomitant strabismus patients（ 108 eyes）underwent strabismus surgery in our hospital from August 2012 to August 2014 were chosen, a randomized, double-blind and placebo-controlled study was performed and randomly allocated to two groups：control group （subconjunctival ropivacaine hydrochloride injection for anesthesia）, and drug group （0.2 mL·mg-1 diazepam injection before local anesthesia）. FRS and SAS were recorded, and the surgery duration, dragging pain and follow-up were observed. Results There were statistical differences in FRS and SAS at intra-operation and post-operation between two groups （ all P 〈 0.05 ）. The surgery duration in drug group was shorter than that in control group （P 〈 0.05 ）. Compared with control group, the dragging reflection pain in drug group was decreased（P 〈 0.05 ）. The patients in drug group was with stable vital signs and well cooperation with ophthalmologist during the operation. Conclusion Diazepare injection before local anesthesia is effective in antianxiety intraoperatively and postoperatively for concomitant strabismus surgery, can reduce the abnormal eye position caused by mental stress, soreness and nausea, reduce the discomfort, provides bet- ter cooperation with the ophthalmologists and reset a better position of eyeball.