球后麻醉及阿托品预处理对小儿斜视手术眼心反射的影响

Influence of retrobulbar anesthesia or atropine pretreatment before strabismus surgery for oculocardiac reflex in children

目的:比较全身麻醉、全身麻醉联合球后麻醉或阿托品三种麻醉方法对小儿斜视手术眼心反射(oculocardiac reflex,OCR)发生率的影响。方法:将2015-03/2016-03在我院行斜视矫正手术并采用全身麻醉的5~13岁患者92例166眼纳入研究,随机分为全身麻醉组29例55眼、全身麻醉+球后麻醉组31例54眼、全身麻醉+阿托品组32例57眼;全身麻醉组采用静脉注射丙泊酚2mg/kg、芬太尼1mg/kg和阿曲库铵0.5mg/kg。全身麻醉+球后麻醉组于全身麻醉基础上球后注射20g/L利多卡因2mL。全身麻醉+阿托品组于全身麻醉基础上于术前加用静脉注射阿托品0.15mg/kg。手术期间牵拉眼外肌所造成的最低心率低于心率基线值的10%以上或出现心律失常即为OCR阳性。记录术前心率基线值,术中手术时间、麻醉时间及术中OCR发生的肌肉数,术后随访6mo并记录眼球正位例数。结果:全身麻醉+球后麻醉组的OCR发生率最低(20%),其次为全身麻醉+阿托品组(22%),两种麻醉方法OCR发生率均低于全身麻醉组(58%)。三种麻醉方法在麻醉时间、手术时间、心率基线值以及手术后眼位正位率方面无统计学差异(P>0.05)。结论:小儿斜视全身麻醉手术联合球后麻醉或阿托品预处理,可有效地降低术中OCR的发生率,能够为斜视患儿提供更安全的手术保障。

·AIM： To assess the effect of applying retrobulbar anesthesia or atropine pretreatment as an available method to prevent oculocardiac reflex （ OCR） . ·METHODS：A total of 92 pediatric patients （ 166 eyes ） aged 5-13 years old who underwent elective strabismus surgery from March 2015 to March 2016 were enrolled and randomly assigned into three groups. Traditional anesthesia （ TA ） group was intravenously injected with propofol 2 mg/kg, fentanyl 1 mg/kg and atracurium 0. 5mg/kg. Retrobulbar anesthesia （ RA） group received both traditional anesthesia and retrobulbar injection of 2%lidocaine 2mL. Atropine pretreatment （ AP ） group received both traditional anesthesia and intravenous injection of atropine 0. 15 mg/kg before surgery. The heart rate decreased by over 10% from the baseline value was considered as OCR positive. The anesthesia time, operation time, the baseline value of heart rate and the muscles induced OCR were recorded and analyzed. ·RESULTS：The incidence of intraoperative OCR was 20%in RA group, 22% in AP group and 58% in TA group. There was no significant difference in anesthesia time, operation time, the baseline value of heart rate and corrective rate of postoperative eye position among three groups （P〉0. 05）. ·CONCLUSION： Retrobulbar anesthesia and atropine pretreatment both effectively reduced the incidence of OCR in children＇s strabismus surgery, which could be potentially effective methods to prevent OCR and further provide more operation security for children with strabismus.