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球后神经阻滞联合全身麻醉在角膜移植术中的应用研究

赖爱华 张璜 游珊 孙涛 刘贤 周文天

赖爱华, 张璜, 游珊, 等. 球后神经阻滞联合全身麻醉在角膜移植术中的应用研究[J]. 器官移植, 2019, 10(5): 578-583. doi: 10.3969/j.issn.1674-7445.2019.05.018
引用本文: 赖爱华, 张璜, 游珊, 等. 球后神经阻滞联合全身麻醉在角膜移植术中的应用研究[J]. 器官移植, 2019, 10(5): 578-583. doi: 10.3969/j.issn.1674-7445.2019.05.018
Lai Aihua, Zhang Huang, You Shan, et al. Application of retrobulbar nerve block combined with general anesthesia in corneal transplantation[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 578-583. doi: 10.3969/j.issn.1674-7445.2019.05.018
Citation: Lai Aihua, Zhang Huang, You Shan, et al. Application of retrobulbar nerve block combined with general anesthesia in corneal transplantation[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 578-583. doi: 10.3969/j.issn.1674-7445.2019.05.018

球后神经阻滞联合全身麻醉在角膜移植术中的应用研究

doi: 10.3969/j.issn.1674-7445.2019.05.018
基金项目: 

江西省教育厅科学技术研究项目 180107

详细信息
    通讯作者:

    赖爱华,女,1977年生,本科,副主任医师,研究方向为眼科麻醉,Email:lah124578s@163.com

  • 中图分类号: R617, R614

Application of retrobulbar nerve block combined with general anesthesia in corneal transplantation

More Information
  • 摘要:   目的  探讨球后神经阻滞联合全身麻醉(全麻)在穿透性角膜移植术(PKP)中的应用价值。  方法  研究对象选择2017年1月至2019年1月期间行PKP的100例受者。采用随机数字表法将受者分为观察组50例)与对照组(50例)。对照组行喉罩通气全麻术;观察组行喉罩通气全麻术联合球后神经阻滞技术。观察两组PKP受者手术前后血流动力学改变、术中镇痛剂使用量以及并发症的发生情况,采用视觉模拟评分法(VAS)评估两组受者术后2、6、24 h疼痛程度,观察两组受者的苏醒情况。比较两组受者术前1 d及术后1 d的炎症因子水平。  结果  观察组在术中15 min、手术结束时的平均动脉压、心率明显高于对照组(均为P < 0.05)。观察组受者术中瑞芬太尼和丙泊酚的使用量分别为(1.0±0.4)、(299±40)mg,明显低于对照组受者的(1.3±0.6)、(365±42)mg(均为P < 0.05)。两组并发症发生率的比较均无统计学意义(均为P > 0.05)。观察组受者在术后2、6、12 h的VAS评分均低于对照组受者(均为P < 0.01)。观察组受者呼吸恢复、呼之睁眼、定向力恢复及拔管时间均短于对照组受者(均为P < 0.05)。观察组受者术后1 d的白介素(IL)-1、IL-6及肿瘤坏死因子(TNF)-α水平均低于对照组受者(均为P < 0.05)。  结论  球后神经阻滞联合全麻可以维持PKP术中血流动力学稳定,降低瑞芬太尼与丙泊酚使用量,减轻受者术后疼痛程度以及炎症反应。

     

  • 图  1  两组PKP受者术中血流动力学变化情况的比较

    T1为入手术室时; T2为手术开始时; T3为手术后15 min时; T4为手术结束时; T5为拔管时; T6为拔管5 min后。与对照组比较,aP < 0.05。10 mmHg=1.33 kPa

    Figure  1.  Comparison of intraoperative hemodynamic changes of PKP recipients between two groups

    图  2  两组受者术后疼痛程度及苏醒情况的比较

    A图为VAS评分比较,B图为苏醒情况比较

    Figure  2.  Comparison of postoperative pain and awakening situation of recipients between two groups

    图  3  两组受者炎症因子水平的比较

    Figure  3.  Comparison of inflammatory cytokines levels of recipients between two groups

  • [1] GRZYBOWSKI A, PATRYN R. Current state of corneal transplants in Poland[J]. Acta Ophthalmol, 2018, 96(1):e93-e94. DOI: 10.1111/aos.13406.
    [2] ZHANG Y, HU Y, LI X, et al. Observation of corneal transplantation in peripheral corneal disease postoperatively[J]. Exp Ther Med, 2018, 15(6):5384-5388. DOI: 10.3892/etm.2018.6100.
    [3] ZHONG W, MONTANA M, SANTOSA SM, et al. Angiogenesis and lymphangiogenesis in corneal transplantation-a review[J]. Surv Ophthalmol, 2018, 63(4):453-479. DOI: 10.1016/j.survophthal.2017.12.008.
    [4] TSAI CY, HOU YC. Endothelial keratoplasty for failed penetrating keratoplasty grafts[J]. J Formos Med Assoc, 2018, 117(2):166-168. DOI: 10.1016/j.jfma.2017.05.013.
    [5] ALARRAYEDH H, COLLUM L, MURPHY CC. Outcomes of penetrating keratoplasty in congenital hereditary endothelial dystrophy[J]. Br J Ophthalmol, 2018, 102(1):19-25. DOI: 10.1136/bjophthalmol-2016-309565.
    [6] DOLGUN E, YAVUZ M, EROĞLU B, et al. Investigation of preoperative fasting times in children[J]. J Perianesth Nurs, 2017, 32(2):121-124. DOI: 10.1016/j.jopan.2014.12.005.
    [7] SCHMIDT AR, BUEHLER KP, BOTH C, et al. Liberal fluid fasting: impact on gastric pH and residual volume in healthy children undergoing general anaesthesia for elective surgery[J]. Br J Anaesth, 2018, 121(3):647-655. DOI: 10.1016/j.bja.2018.02.065.
    [8] WANG X, DANG GF, LI YM, et al. General anesthesia versus local anesthesia for penetrating keratoplasty: a prospective study[J]. Int J Ophthalmol, 2014, 7(2):278-282. DOI: 10.3980/j.issn.2222-3959.2014.02.15.
    [9] 熊利泽, 陈宇.从麻醉学到围术期医学[J].医学与哲学, 2016, 37(10):8-12.DOI: 10.12014/j.issn.1002-0772.2016.05b.03.

    XIONG LZ, CHEN Y. From anesthesiology to perioperative medicine[J]. Med Philos, 2016, 37(10):8-12. DOI: 10.12014/j.issn.1002-0772.2016.05b.03.
    [10] 王丙海.罗哌卡因联合地佐辛对颅脑外科手术患者全麻恢复期躁动的影响[J].现代中西医结合杂志, 2016, 28(8):896-898.DOI: 10.3969/j.issn.1008-8849.2016.08.037.

    WANG BH. Effect of ropivacaine combined with dizocine on restlessness during general anesthesia in patients undergoing cranial surgery[J]. Mod J Integr Tradit Chin West Med, 2016, 28(8):896-898. DOI: 10.3969/j.issn.1008-8849.2016.08.037.
    [11] 姜柏林, 赵红, 姚兰, 等.芬太尼与球后神经阻滞联合瑞芬太尼在小儿全麻眼科手术中的对比研究[J/CD].中华临床医师杂志(电子版), 2016, 10(9): 1287-1291. DOI: 10.3877/cma.j.issn.1674-0785.2016.09.020.

    JIANG BL, ZHAO H, YAO L, et al. A comparative study in children undergoing ophthalmologic surgery during general anesthesia: systemic fentanyl vs. retrobulbar block combined with remifentanyl[J/CD]. Chin J Clin (Electr Edit), 2016, 10(9): 1287-1291. DOI: 10.3877/cma.j.issn.1674-0785.2016.09.020.
    [12] KHAIRALLAH A. Descemet stripping automated endothelialkeratoplasty (DSAEK) versus repeat penetrating keratoplasty (PKP) to manage eyes with failed corneal graft[J]. Ann Saudi Med, 2018, 38(1):36-41. DOI: 10.5144/0256-4947.2018.36.
    [13] BARRAQUER RI, PAREJA-ARICÒ L, GÓMEZ-BENLLOCH A, et al. Risk factors for graft failure after penetrating keratoplasty[J]. Medicine (Baltimore), 2019, 98(17):e15274. DOI: 10.1097/MD.0000000000015274.
    [14] JABBEHDARI S, RAFⅡ AB, YAZDANPANAH G, et al. Update on the management of high-risk penetrating keratoplasty[J]. Curr Ophthalmol Rep, 2017, 5(1):38-48. DOI: 10.1007/s40135-017-0119-2.
    [15] CHUA A, CHUA MJ, KAM P. Recent advances and anaesthetic considerations in corneal transplantation[J]. Anaesth Intensive Care, 2018, 46(2):162-170. doi: 10.1177/0310057X1804600204
    [16] HIRANO K, KACHI S, MATSUURA M, et al. Non-descemet stripping automated endothelial keratoplasty for bullous keratopathy in buphthalmic eye[J]. Case Rep Ophthalmol, 2016, 7(2):279-284. DOI: 10.1159/000446103.
    [17] SHIMMURA-TOMITA M, SHIMMURA S, TSUBOTA K, et al. Penetrating keratoplasty performed by residents compared with an experienced cornea transplant surgeon[J]. J Surg Educ, 2017, 74(2):258-263. DOI: 10.1016/j.jsurg.2016.08.003.
    [18] SERNA-OJEDA JC. Therapeutic penetrating keratoplasty[J]. Eye Contact Lens, 2019, 45(3):212. DOI: 10.1097/ICL.0000000000000565.
    [19] ÖZEK D, KEMER ÖE, ÖNEN M, et al. Penetrating keratoplasty in patients with traumatic corneal scarring[J]. Ulus Travma Acil Cerrahi Derg, 2019, 25(2):172-176. DOI: 10.5505/tjtes.2017.18949.
    [20] AMANN EM, GROß A, ROJEWSKI MT, et al. Inflammatory response of mesenchymal stromal cells after in vivo exposure with selected trauma-related factors and polytrauma serum[J]. PLoS One, 2019, 14(5):e0216862. DOI: 10.1371/journal.pone.0216862.
    [21] LOFTUS TJ, THOMSON AJ, KANNAN KB, et al. Clonidine restores vascular endothelial growth factor expression and improves tissue repair following severe trauma[J]. Am J Surg, 2017, 214(4):610-615. DOI: 10.1016/j.amjsurg.2017.06.019.
    [22] 许淼, 杨勇, 邓绮文, 等.LncRNA与凋亡相关基因在小鼠肠缺血再灌后肠黏膜表达谱中的变化及共表达网络关系[J].中山大学学报(医学科学版), 2019, 40(1):1-13. http://d.old.wanfangdata.com.cn/Periodical/zsykdxxb201901001

    XU M, YANG Y, DENG QW, et al. Microarray profiling and co-expression analysis of long noncoding RNA and apoptosis-associated mRNA in mouse intestinal mucosa following intestinal ischemia/reperfusion injury[J]. J Sun Yat-sen Univ(Med Sci), 2019, 40(1):1-13. http://d.old.wanfangdata.com.cn/Periodical/zsykdxxb201901001
    [23] 曾思, 陈静, 陆维莎, 等.右美托咪定联合球后神经阻滞在小儿眼球摘除眼座置入术中的应用[J].国际麻醉学与复苏杂志, 2018, 39(2):112-115.DOI: 10.3760/cma.j.issn.1673-4378.2018.02.004.

    ZENG S, CHEN J, LU WS, et al. Combination of dexmedetomidine with retrobulbar block in pediatric patients undergoing enucleation of eyeballs[J]. Int J Anesth Resus, 2018, 39(2):112-115. DOI: 10.3760/cma.j.issn.1673-4378.2018.02.004.
    [24] CHLOROPOULOU P, IATROU C, VOGIATZAKI T, et al. Epidural anesthesia followed by epidural analgesia produces less inflammatory response than spinal anesthesia followed by intravenous morphine analgesia in patients with total knee arthroplasty[J]. Med Sci Monit, 2013, 19:73-80. doi: 10.12659/MSM.883749
    [25] RAHIMI VARPOSHTI M, MORADI FARSANI D, GHADIMI K, et al. Reduction of oculocardiac reflex with tetracaine eye drop in strabismus surgery[J]. Strabismus, 2019, 27(1):1-5. DOI: 10.1080/09273972.2018.1561732.
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出版历程
  • 收稿日期:  2019-07-18
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-09-15

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