罗哌卡因添加右美托咪定在义眼台置入术中的麻醉效果研究(1)
[摘要]目的：为获得良好的麻醉效果，尽可能减少患者术后不适，并确保麻醉安全，探讨罗哌卡因添加右美托咪定在一期义眼台置入术中的临床麻醉效果及安全性。方法：2012年2月-2018年2月，笔者对36例(36眼)因眼球萎缩、眼球破裂、难治性青光眼的患者行一期义眼台置入术，术中采用0.75%罗哌卡因中添加右美托咪定0.5μg/kg行球后麻醉及眼球筋膜下麻醉配合手术。结果：36例患者术中生命体征平稳，麻醉效果良好，患者无疼痛难忍现象，配合度好。术后疼痛轻﹑结膜水肿及恶心呕吐症状均较轻。结论：在一期义眼台置入术中应用罗哌卡因添加右美托咪定，能延长感觉与运动阻滞的持续时间，并且有很好的术后镇痛效果。
[关键词]罗哌卡因；右美托咪定；义眼台；置入术；麻醉；镇痛
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0101-02
Study on Anesthetic Effect of Dexmedetomidine Added to Ropivacaine in One-stage Ocular Prosthesis Implantation
, http://www.100md.com
YANG Qian-qian，LIU De-cheng
(Department of Ophthalmology，the Seventh People's Hospital of Zhengzhou，Zhengzhou 450016，Henan，China)
Abstract： Objective In order to obtain a good anesthesia effect， reduce the patients postoperative discomfort as much as possible， and ensure the safety of anesthesia. To explore the clinical anesthesia effect and safety of dexmedetomidine added to ropivacain in one-stage ocular prosthesis implantation. Methods From February 2012 to February 2018， 36 patients (36 eyes) with atrophy of the eyeball， rupture of the eyeball and refractory glaucoma were treated with one-stage Ocular prosthesis implantation. During the operation， dexmedetomidine of 0.5μg/kg added to 0.75% ropivacaine for retrobulbar anesthes and subtascia loacl anesthesia. Results 36 patients had stable vital signs and good cooperation during operation. No pain or intolerable phenomenon occurred. Postoperative pain， conjunctival edema and nausea and vomiting were mild in all patients. Conclusion Dexmedetomidine added to ropivacaine for the treatment retrobulbar anesthesia in one-stage prosthesis implantation canaccelerate the onset time of sensory and motor blocks， prolong the duration of sensory and motor blocks，and provide more effective postoperative analgesia.
, 百拇医药
Key words： ropivacaine； dexmedetomidine； ocular prosthesis； implantation； anesthesia； analgesia
眼球摘除或眼內容物摘除术后，若不放置眶内容物来填补眼球所占空间，安装义眼后，往往会出现上睑凹陷﹑义眼活动不良﹑结膜囊畸形等。如加大义眼矫正畸形，往往造成下睑移位﹑下睑松弛。羟基磷灰石(Hydroxyapatite，HA)义眼台行眼眶内置入已广泛应用于临床，但术中及术后疼痛仍是临床亟需解决的问题[1]。笔者医院于2012年2月-2018年2月，在一期义眼台置入术中，采用罗哌卡因添加右美托咪定行球后麻醉及眼球筋膜下麻醉，术中及术后镇痛效果良好，现报道如下。
1 资料和方法
1.1 临床资料：本组36例(36眼)。其中男20例，女16例；年龄14～68岁；眼球萎缩20例(20眼)，眼球破裂伤13例(13眼)，难治性青光眼3例(3眼)。术中所置入HA义眼台，直径为20～22mm，孔径500μm，均为美国进口，用罗哌卡因地塞米松生理盐水浸泡30min。术前全过程临床监测血氧饱和度、心率、血压、心电图变化，以观察是否出现低氧血症和眼心反射。
1.2 手术方法：用0.75%罗哌卡因加右美托咪定0.5μg/kg，分别行球后及结膜下阻滞麻醉。沿角膜缘剪开一周球结膜及眼球筋膜筋膜并分离，改良式眼内容物摘除术[2]。用6-0可吸收缝线做外直肌固定缝线后剪断外直肌。消除所有眼内容物，用碘酊灼烧巩膜内侧壁，预防交感性眼炎的发生，将义眼台置入肌锥腔。将外直肌断端原位缝合。缝合巩膜切口及眼球筋膜及球结膜切口。结膜囊内涂四环素可的松眼膏，置透明眼模，加压包扎72h后打开，点消炎眼药水。, 百拇医药(杨倩倩 刘德成)
[关键词]罗哌卡因；右美托咪定；义眼台；置入术；麻醉；镇痛
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0101-02
Study on Anesthetic Effect of Dexmedetomidine Added to Ropivacaine in One-stage Ocular Prosthesis Implantation
, http://www.100md.com
YANG Qian-qian，LIU De-cheng
(Department of Ophthalmology，the Seventh People's Hospital of Zhengzhou，Zhengzhou 450016，Henan，China)
Abstract： Objective In order to obtain a good anesthesia effect， reduce the patients postoperative discomfort as much as possible， and ensure the safety of anesthesia. To explore the clinical anesthesia effect and safety of dexmedetomidine added to ropivacain in one-stage ocular prosthesis implantation. Methods From February 2012 to February 2018， 36 patients (36 eyes) with atrophy of the eyeball， rupture of the eyeball and refractory glaucoma were treated with one-stage Ocular prosthesis implantation. During the operation， dexmedetomidine of 0.5μg/kg added to 0.75% ropivacaine for retrobulbar anesthes and subtascia loacl anesthesia. Results 36 patients had stable vital signs and good cooperation during operation. No pain or intolerable phenomenon occurred. Postoperative pain， conjunctival edema and nausea and vomiting were mild in all patients. Conclusion Dexmedetomidine added to ropivacaine for the treatment retrobulbar anesthesia in one-stage prosthesis implantation canaccelerate the onset time of sensory and motor blocks， prolong the duration of sensory and motor blocks，and provide more effective postoperative analgesia.
, 百拇医药
Key words： ropivacaine； dexmedetomidine； ocular prosthesis； implantation； anesthesia； analgesia
眼球摘除或眼內容物摘除术后，若不放置眶内容物来填补眼球所占空间，安装义眼后，往往会出现上睑凹陷﹑义眼活动不良﹑结膜囊畸形等。如加大义眼矫正畸形，往往造成下睑移位﹑下睑松弛。羟基磷灰石(Hydroxyapatite，HA)义眼台行眼眶内置入已广泛应用于临床，但术中及术后疼痛仍是临床亟需解决的问题[1]。笔者医院于2012年2月-2018年2月，在一期义眼台置入术中，采用罗哌卡因添加右美托咪定行球后麻醉及眼球筋膜下麻醉，术中及术后镇痛效果良好，现报道如下。
1 资料和方法
1.1 临床资料：本组36例(36眼)。其中男20例，女16例；年龄14～68岁；眼球萎缩20例(20眼)，眼球破裂伤13例(13眼)，难治性青光眼3例(3眼)。术中所置入HA义眼台，直径为20～22mm，孔径500μm，均为美国进口，用罗哌卡因地塞米松生理盐水浸泡30min。术前全过程临床监测血氧饱和度、心率、血压、心电图变化，以观察是否出现低氧血症和眼心反射。
1.2 手术方法：用0.75%罗哌卡因加右美托咪定0.5μg/kg，分别行球后及结膜下阻滞麻醉。沿角膜缘剪开一周球结膜及眼球筋膜筋膜并分离，改良式眼内容物摘除术[2]。用6-0可吸收缝线做外直肌固定缝线后剪断外直肌。消除所有眼内容物，用碘酊灼烧巩膜内侧壁，预防交感性眼炎的发生，将义眼台置入肌锥腔。将外直肌断端原位缝合。缝合巩膜切口及眼球筋膜及球结膜切口。结膜囊内涂四环素可的松眼膏，置透明眼模，加压包扎72h后打开，点消炎眼药水。, 百拇医药(杨倩倩 刘德成)