双眼有晶体眼后房型人工晶体植入手术患者两次手术疼痛对比

Comparison of pain between two eye operations in patients undergoing implantable collamer lens implantation

目的比较表面麻醉下的有晶体眼后房型人工晶体(ICL)植入手术双眼术前紧张程度、术中疼痛及配合度等,分析双眼疼痛是否存在差异及寻找可能的原因,探寻ICL手术双眼之间的合理间隔期。方法入组分次行双眼ICL手术的120例患者中男18例、女102例,将患者随机分为间隔1 d组及间隔1周组,患者双眼按间隔时间行ICL手术,所有手术均为表面麻醉,经透明角膜切口行ICL植入术。每只眼术前使用视觉模拟(VAS)量表评价患者紧张程度,术中术者评估患者配合程度,记录手术耗时,术后使用VAS量表评估患者术中疼痛程度及整体满意度,患者估计手术耗时。统计学分析比较双眼评分变化和组间差异,并探求疼痛程度与患者一般资料的关系。结果不管是在间隔1 d组还是间隔1周组,患者在第二眼手术时紧张程度较前减轻(1 d组:P<0.01;1周组:P=0.011),疼痛程度明显升高(两组均:P<0.01),手术满意程度变差(两组均P=0.001),估计手术时间延长(两组均P<0.01)。在第二眼术中,患者配合程度变差(两组均:P=0.002),但并不会导致手术耗时的增加(1 d组:P=0.481;1周组:P=0.499)。在第二只眼手术时,有相当一部分患者回忆第一只眼的疼痛会偏低,在1周组差异有统计学意义(1 d组:P=0.082;1周组:P=0.011)。间隔1周组较间隔1 d组第二只眼相对于第一只眼的各指标的变化程度更大,但各指标组间比较差异无统计学意义(P>0.05)。多因素回归分析及多独立样本非参数检验显示,年轻的、未生育的人倾向于有较高的疼痛程度。结论第二只眼ICL手术患者的紧张程度较第一只眼降低,疼痛较前增加,配合度降低,这可能主要与心理因素有关,需要积极进行心理干预。双眼手术间隔1 d时和间隔1周时差别不大,可以根据需要选择ICL手术双眼间隔期。

Objective The objective of this study was to compare the degree of tension,pain,and cooperation between patients who underwent two implantable collamer lens(ICL)implantation surgeries under surface anesthesia,and to analyze whether there was a difference in pain between the two eyes and explore the possible causes of the pain in order to examine the ideal interval between two ICL operations.Methods A total of 120 patients who underwent binocular ICL surgery were enrolled.Among them,18 were men and 102 were women.Patients were randomly divided into 1-day and 1-week interval groups.ICL implantation surgeries were performed in both eyes according to the research plan.All operations were performed under surface anesthesia,and ICL implantation was performed using a transparent corneal incision.The degree of tension of patients was evaluated by a visual analog scale(VAS)before the operation.The degree of cooperation of patients and the operation duration were evaluated and recorded during the operation,and the degrees of pain and overall satisfaction were evaluated by a VAS scale after the operation.Additionally,patients were asked to estimate the operation duration.The difference between binocular score in the two groups was statistically analyzed and compared,as well as the relationship between the degree of pain and the general information of patients such as gender,age and so on.Results In both the 1-day and 1-week interval groups,the tension of the patients during the second eye surgery was reduced(1-day interval group:P<0.01;1-week interval group:P=0.011),the degree of pain significantly increased(both groups:P<0.01),the degree of satisfaction decreased(both groups:P=0.001),and the estimated operation duration was longer(both groups:P<0.01).In the second eye surgery,the degree of cooperation of patients declined(both groups:P=0.002),but it did not lead to an increase in the estimation of operation duration(1-day interval group:P=0.481;1-week interval group:P=0.499).Also during the second eye surgery,a significant number of patients underestimated the pain they had experienced during the first eye surgery.The bias of memory of the 1-week interval group was statistically significant(1-day interval group:P=0.082;1-week interval group:P=0.011.The changes in all indexes between the first and second eyes in the 1-week interval group were greater than those in the 1-day interval group,but there were no significant differences between groups(P>0.05).Multivariate regression analysis and nonparametric tests with multiple independent samples showed that young people without childbirth history tended to experience higher levels of pain during surgery.Conclusion Compared with the first eye surgery,the degree of tension decreased,the amount of pain increased,and the degree of cooperation decreased in the second eye surgery.This result may be mainly related to psychological factors;therefore,psychological intervention is warranted before the second eye surgery.No significant difference in pain existed between the 1-day and 1-week interval groups.Our results indicate that the time interval between two eye surgeries can be determined according to the patient’s request.