表面麻醉下超声乳化手术各阶段镇痛效果的评价

The Evaluation of the Eflect of Analgesia at Different Stages of Phacoemusification under Topical Anesthesia

目的评价表面麻醉下白内障超声乳化手术二种切口(角膜、巩膜切口)不同手术阶段疼痛感觉及镇痛效果。方法铺巾前、开睑后滴"0.4%爱而卡因"表面麻醉剂二次后手术。随机选择角膜切口组,巩膜切口组各120例,在手术各阶段中不作任何提示,征询病人疼痛感觉,详细记录按疼痛分级表,并客观评价镇痛效果。结果本组病例手术时间范围5～25min,平均7.2min。两组病例在水分离,超声乳化,清除皮质阶段中角膜切口组3级疼痛以下发生率分别为9.2%,25.0%,12.5%;巩膜切口组分别为12.5%,22.5%,13.3%。二组间差异无显著性(P>0.05)。所有病例均能很好耐受手术,顺利完成手术并植入囊袋内人工晶状体。后囊膜破裂率为3.8%,前囊撕裂率5.8%,无晶状体核坠入玻璃体内和眼内大出血等严重并发症。结论表面麻醉方式行超声乳化手术是安全而有效的。

Purpose To evaluate the effect of analgesia upon two incisions at different stages of phacoemtisification under topical anesthesia. Methods We dropped 0.4% alcaine twice before spreading scarf and after opening eyelid respectively and select 120 cotneal incisions and 120 scleral incisions randomly. Without any cue, we asked patients about the feelings at each stage and classified them objectively. Results The average time of operation was 7.2 minutes, arranged from 5 to 25 minutes, In comeal incision, the pain under grade 3 was 9.2%, 25% and 12.5% during hydrodissection, emusification and aspiration of cortex respectively, which in scleral incisions was 12.5%, 22.5% and 13.3% respectively. There was no significant statistic difference between these two groups( P < 0.05) . All of them could tolerate the operation and surgeons could successfully implant the lens. The ratio of postcapsule disrupton was 3.8% and the ratio of anterior capsule laceration was 5.8% . No nuclear dropping into vitreous and intraocular hematorrhea happned. Conclusion phacomusification under topical anesthesia is safe and effective.