针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的应用

Application of Acupuncture Anesthesia in Age-Related Cataract Phacoemulsification Combined with Intraocular Lens Implantation

目的观察针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的临床应用效果。方法纳入年龄相关性白内障且预行超声乳化联合人工晶体植入术的患者100例,随机分为对照组49例和观察组51例。对照组给予0.5%盐酸丙美卡因滴眼液表面麻醉,观察组在对照组基础上联合针刺麻醉,记录2组在手术开始前(T0)、前房穿刺前(T1)、超声乳化时(T2)、推注人工晶体时(T3)、手术结束后(T4)的心率、外周血氧饱和度、收缩压(SBP)和舒张压(DBP),比较2组在不同时间点各项指标水平,心率变化差异及术后视觉模拟评分法(VAS)疼痛评分。结果2组患者年龄、性别、术前生命体征等基线数据均无统计学意义(P>0.05)。(1)心率、外周血氧饱和度:与对照组比较,观察组在T1、T2、T3、T4的心率、外周血氧饱和度均无统计学意义(P>0.05),但是观察组T1、T2、T3、T4与T0相差的心率变化均变小,ZT_(1)=-3.644,P=0.001;ZT_(2)=-3.201,P=0.001;ZT_(3)=-2.255,P=0.024;ZT_(4)=-2.319,P=0.020,差异均有统计学意义。(2)血压:与对照组比较,观察组在各时间点SBP和DBP水平均降低,t_(SBP-T1)=3.257,P=0.002;t_(SBP)-T2=3.232,P=0.002;t_(SBP)-T3=4.135,P=0.000;t_(SBP)-T4=3.054,P=0.003;t_(DBP-T1)=2.697,P=0.008;t_(DBP-T2)=2.689,P=0.008;t_(DBP-T3)=3.157,P=0.002;tDBP-T4=3.510,P=0.000,差异均有统计学意义。(3)VAS评分:观察组术后疼痛强度明显降低,Z=5.434,P=0.000,差异具有统计学意义。结论针刺麻醉在年龄相关性白内障超声乳化联合人工晶体植入术中的应用安全有效,能够维持患者术中心率、血氧饱和度稳定,显著缓解血压升高,减轻患者的疼痛程度。

OBJECTIVE To observe the clinical application of acupuncture anesthesia in phacoemulsification combined with intraocular lens(IOL)implantation for age-related cataract.METHODS A total of 100 cases of age-related cataract patients who underwent phacoemulsification combined with IOL implantation surgery were randomly divided into a control group(49 cases)and an observation group(51 cases).The control group received routine surface anaesthesia with proxymetacaine hydrochloride 0.5%eyedrops,and the observation group received acupuncture anesthesia combined with surface anesthesia.Levels of heart rate,peripheral oxygen saturation,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the two groups were compared at the following time points:Before operation(T0),before anterior chamber puncture(T1),in the course of phacoemulsification probe entrance(T2)and IOL implantation(T3),and at the end of operation(T4).The differences of blood pressure in T1,T2,T3 and T4 compared with T0 were also calculated.Furthermore,scores of Visual Analogue Scale(VAS)were analysed after surgery.RESULTS There were no significant differences in age,gender and preoperative vital signs between the two groups before the treatment(P>0.05).Compared with the control group,there were no significant differences in heart rate and peripheral blood oxygen saturation in the observation group at T1,T2,T3 and T4(P>0.05).The heart rate changes of T1,T2,T3,T4 based on T0 in the observation group were smaller,and the differences were statistically significant(ZT_(1)=-3.644,P=0.001;ZT_(2)=-3.201,P=0.001;ZT_(3)=-2.255,P=0.024;ZT_(4)=-2.319,P=0.020).SBP and DBP in the observation group were decreased,and the differences were statistically significant(t_(SBP-T1)=3.257,P=0.002;t_(SBP)-T2=3.232,P=0.002;t_(SBP)-T3=4.135,P=0.000;t_(SBP)-T4=3.054,P=0.003;t_(DBP-T1)=2.697,P=0.008;t_(DBP-T2)=2.689,P=0.008;t_(DBP-T3)=3.157,P=0.002;tDBP-T4=3.510,P=0.000).In addition,compared with the control group,postoperative pain intensity decreased significantly in the observation group,and the difference was statistically significant(Z=5.434,P=0.000).CONCLUSIONS Acupuncture anesthesia is safe and effective for phacoemulsification combined with IOL implantation surgery in age-related cataract patients,which can maintain the stability of heart rate and peripheral oxygen saturation,relieve the rise of blood pressure,and reduce pains of patients.