准分子激光患者术前焦虑对术中眼动模式的影响

Impact of Preoperative Anxiety of LASIK Patients on Intraoperative Eye Movement Patterns

目的探讨准分子激光(laser-assisted in situ keratomileusis,Lasik)患者术前焦虑度对术中眼动模式的影响。方法根据焦虑自评量表(self-rating anxiety scale,SAS)评估患者焦虑程度,将患者分为两组,A组为轻中度焦虑者130例260只眼,B组为重度焦虑者30例60只眼。前瞻性观察两组患者术中的注视状态、注视时间及注视眼位的变化,从而了解两组患者术中配合情况。分析患者术前焦虑水平与术中眼动模式的关联。结果两组患者焦虑评分分别为:A组(38.9±5.6)和B组(46.4±6.5),两组比较差异有显著意义(P﹤0.05)。焦虑程度小者多能双眼注视,焦虑程度重者多单眼注视,平均注视时间分别为:A组(19.3±6.1)min,B组(7.48±3.0)min,两组比较差异有非常显著意义(P﹤0.001)。A组患者103例205只眼,固视无偏移、无停机,其中24例46只眼有轻微漂移,机器能跟踪,5例9只眼眼球上翻而停机调整;B组6例12只眼偏移范围较小,23例46只眼眼球转动明显偏移,其中眼位上翻39只眼(占86.7%),机器不能跟踪而停机,其中1例患者感觉呼吸困难而停手术。A组患者调整眼位及停机次数明显少于B组,两组比较有显著意义(P﹤0.05)。结论术前患者焦虑因子影响患者的注视状态。焦虑程度轻者能自主控制,多数呈双眼注视状态,平均注视时间长,停机次数少。过度焦虑者,术中不能双眼注视,术中固视能力差。行手术前应加强心理护理,缓解患者的焦虑程度,固视训练时及术中叮嘱患者一定双眼同时注视。

Objective To investigate the impact of the preoperative anxiety of LASIK patients on their eye movement patterns in the process of the operation. Methods Based on the results of self-evaluation of anxiety scale （ SAS）, the patients were divided into two groups ： Group A （ consisting of 130 patients of mild-to-moderate anxiety） and Group B group （ consisting of 30 patients of severe anxiety）. The patients of the two groups were observed prospectively for visual fixation states and periods and fixation location changes to know how they were cooperative in the process of the operation. The correlation between the preoperative anxiety levels and intraoperative eye movement patterns was analyzed. Results The anxiety scores of the two groups were （38.95 ± 5.6） and （46. 36 ± 6.5） respectively （P〈0.05）. While most of the patients of lower anxiety levels performing fixation with both eyes, those of higher anxiety levels were mainly observed with monocular fixation. The average fixation time was （19.26±6.1） for Group A and （7.48±3.0） for Group B （P〈 0.001）. In Group A, 103 patients （205 eyes） were observed of fixation without offset, which led to uninterrupted operation of the machine; 24 patients （46 eyes） were found with mild drift that could be tracked with the machine; and 5 patients （9 eyeS） were noticed of eyeball upturning, which led to closedown of the machine for adjustments. In group B, 6 patients （ 12 eyes） were observed of small offset, and 23 patients （46 eyes） of Significant offset （including 39 eyes turned upward, accounting for 86.7% ） that led to the shutdown of machine for adjustments, among which a .patient was given an unfinished operation because of difficult breathing. Both the amount of eye adjustment and number of shutdown of machine of group A were less than those of group B, and the differences were statistically significant. Conclusions Preoperative anxiety factors will affect fixation states. Patients of low-level anxiety may perform independent control and fixation with both eyes, have long period of fixation and require less downtime. On the other hand, over-anxious patients Cannot perform fixation of both eyes and their intraoperative fixation ability is poor. Therefore, preoperative psychological nursing should be strengthened to alleviate their anxiety, and the patients should be instructed to preform fixation with both eyes during the fixation training and the operation.