不同眼表保护方法在头颈部全身麻醉手术中的眼表保护作用效果分析

Effects of different eye protection methods during head and neck surgery under general anesthesia

目的比较红霉素眼膏联合3M透明膜和维生素A眼用凝胶联合3M透明膜在头颈部全身麻醉手术中的眼表保护作用。方法选择2021年6至12月在首都医科大学附属北京同仁医院择期行全身麻醉下头颈部手术的患者120例,其中男58例,女62例,年龄(46±12)岁。采用随机数字表法将患者分为两组:红霉素眼膏联合3M透明膜组(简称红霉素眼,n=60)和维生素A眼用凝胶联合3M透明膜组(简称维A眼,n=60)。红霉素眼滴入红霉素眼膏,之后使用3M透明膜粘贴;维A眼滴入维生素A眼用凝胶,之后也使用3M透明膜粘贴;两组患者的对照眼均单纯使用3M透明膜粘贴。对每例患者在麻醉诱导前、麻醉恢复室(PACU)内以及术后1 d进行3次手持裂隙灯检查。主要观察指标为各眼别角膜荧光素钠染色(CFS)评分。次要观察指标包括干眼症状评估(SANDE)调查问卷评分、基础泪液分泌试验(SIt)、泪膜破裂时间(BUT)以及不良反应发生率。结果红霉素眼和维A眼在PACU内的CFS评分分别为(0.62±0.16)、(0.13±0.01)分,与诱导前基线指标相比均升高(均P<0.05);且红霉素眼在PACU时的CFS评分高于维A眼(P=0.007)。与诱导前相比,红霉素眼在PACU时的SIt明显增加[(16.0±1.3)比(11.4±4.9)mm,P=0.017],维A眼在PACU时的SIt明显下降[(10.2±3.6)比(12.4±5.5)mm,P=0.046];红霉素眼在PACU时的SIt高于维A眼(P=0.013)。红霉素眼和维A眼在PACU时BUT分别为(6.4±2.5)、(6.8±2.1)s,均低于诱导前(均P<0.05);红霉素眼和维A眼间BUT和SANDE评分差异均无统计学意义(均P>0.05)。红霉素眼在PACU时不良反应包括黏滞感(66.7%,40/60)、结膜充血(21.7%,13/60)、刺痛(8.3%,5/60)、视物模糊(58.3%,35/60),发生率均高于维A眼的30.0%(18/60)、5.0%(3/60)、0、6.7%(4/60)(均P<0.05)。结论对于全身麻醉下头颈部手术患者,与联合使用红霉素眼膏和3M透明膜相比,术中联合使用维A眼用凝胶和3M透明膜能更好地预防术后眼表损伤。

Objective To compare the protective effects of vitamin A eye gel combined with 3M transparent tape and erythromycin eye ointment combined with 3M transparent tape on the eye surface during head and neck surgery under general anesthesia.Methods From June to December 2021,a total of 120 patients undergoing elective head and neck surgery under general anesthesia in Beijing Tongren Hospital,Capital Medical University were enrolled.Each participant was randomly received vitamin A eye gel(vitamin A eye,n=60)or erythromycin eye ointment(erythromycin eye,n=60),followed by 3M transparent tape on one eye,and taping 3M transparent tape alone for the other eye.The hand-held slit lamp examination was performed 3 times at before induction of anesthesia,after resuscitation in the post anesthesia care unit(PACU)and 1 day after surgery.The primary outcome was corneal fluorescein sodium staining(CFS)score.Secondary outcomes included symptom assessment in dry eye(SANDE)questionnaire score,basic tear secretion test(Schirmer I test,SIt),break-up time(BUT)and incidence of adverse reactions.Results Comparison within groups showed that CFS scores were significantly higher in vitamin A eyes and erythromycin eyes at PACU than before induction(P<0.05).Comparison between groups showed that CFS score at PACU in erythromycin eyes(0.62±0.16)was significantly higher than that in vitamin A eyes(0.13±0.01,P=0.007).Compared with before induction,SIt at PACU was significantly increased in the erythromycin eyes[(16.0±1.3)vs(11.4±4.9)mm,P=0.017],and was significantly decreased in vitamin A eyes[(10.2±3.6)vs(12.4±5.5)mm,P=0.046].The BUT in PACU of erythromycin eyes,vitamin A eyes were(6.4±2.5)s,(6.8±2.1)s,respectively,and were significantly decreased compared with before induction(P<0.05).Comparison between groups showed that there was no significant difference in BUT and SANDE in PACU between two groups(P>0.05).For erythromycin eyes,discomfort symptoms in PACU included viscosity(66.7%,40/60),conjunctival congestion(21.7%,13/60),tingling(8.3%,5/60),blurred vision(58.3%,35/60).The incidence of these complications in vitamin A eye was 30.0%(18/60),5.0%(3/60),0 and 6.7%(4/60),respectively,and all the incidences were significantly higher than those of vitamin A eyes(all P<0.05).Conclusion For patients undergoing head and neck surgery under general anesthesia,the combination of vitamin A ocular gel and 3M transparent tape is more effective in prevent postoperative ocular surface injury than the combination of erythromycin ointment and 3M transparent tape.