高眼压下球筋膜囊下麻醉联合表面麻醉在白内障合并原发性闭角型青光眼患者手术中的麻醉效果观察

Clinical observation on the analgesic effect of sub-Tenon's anesthesia combined with topical anesthesia under the condition of high intraocular pressure in patients with cataract and PACG undergoing small incision surgery

目的探讨高眼压下球筋膜囊下麻醉联合表面麻醉在白内障合并原发性闭角型青光眼(PACG)患者手术中的麻醉效果。方法选取我院白内障合并PACG患者82例,采用信封法随机分为联合组(43例43眼)和对照组(39例39眼),均接受白内障囊外摘除术+晶状体植入术+小梁切除术。对照组采取表面麻醉,联合组采取球筋膜囊下麻醉联合表面麻醉。比较两组不同时间点的镇痛效果、术中制动效果、术眼配合度、患者麻醉满意度、术中麻醉并发症。结果术中10、20 min及术毕,联合组疼痛程度均轻于对照组(P<0.05)。联合组术中眼球运动、眼睑挤压的制动效果均优于对照组;配合率及麻醉满意率均高于对照组;麻醉并发症发生率低于对照组(P<0.05)。结论球筋膜囊下麻醉联合表面麻醉能获得更好的镇痛效果,并减少结膜出血、眶压升高等手术并发症,适用于白内障合并PACG手术。

Objective To explore the analgesic effect of sub-Tenon's anesthesia combined with topical anesthesia under the condition of high intraocular pressure in patients with cataract and primary angle closure glaucoma(PACG)undergoing small incision surgery.Methods A total of 82 patients with cataract and PACG who underwent cataract surgery were enrolled.They were randomly divided into combination group(43 cases,43 eyes)and control group(39 cases,39 eyes).All patients underwent extracapsular extraction,lens implantation and trabeculectomy.The control group was treated with topical anesthesia,while the combination group was treated with sub-Tenon's anesthesia and topical anesthesia.The analgesic effect at different time points,intraoperative brake effect,coordination degree of surgical eyes,anesthesia satisfaction of patients,and intraoperative anesthesia complications were compared between the two groups.Results At 10 mins and 20 mins after the start of surgery,and at the end of surgery,pain in the combination group was milder than that in the control group(P<0.05).The brake effects of intraoperative eye movement and eyelid extrusion in the combination group were better than those in the control group(P<0.05).The cooperation rate in the combination group was higher than that in the control group(P<0.05).The anesthesia satisfaction rate in the combination group was higher than that in the control group(P<0.05).The incidence of anesthesia complications such as intraoperative conjunctival bleeding and orbital pressure increase in the experiment group was lower than that in the control group(P<0.05).Conclusion The analgesic effect of sub-Tenon's anesthesia combined with topical anesthesia is better,which can reduce conjunctival hemorrhage and orbital pressure increase.It is suitable for cataract combined with PACG surgery.