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
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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
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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

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

    摘要
  • 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。

     

    Abstract:
      Objective  To explore the application value of retrobulbar nerve block combined with general anesthesia in the penetrating keratoplasty (PKP).
      Methods  A total of 100 recipients undergoing PKP from January 2017 to January 2019 were recruited in this study. All recipients were divided into the observation group (n=50) and control group (n=50) by random number table method. In the control group, patients received laryngeal mask airway under general anesthesia, and in the observation group, patients received laryngeal mask airway under general anesthesia combined with retrobulbar nerve block. Hemodynamic changes of the PKP recipients before and after operation were observed in two groups. The dosage of analgesic drugs and the incidence of complications were observed in two groups. The degree of pain at postoperative 2-, 6- and 24-h was evaluated by visual analogue scale (VAS) in two groups. The awakening situation of the recipients in two groups was observed. The levels of inflammatory cytokines at 1 d before and after operation were statistically compared in two groups.
      Results  The average arterial pressure and heart rate at intraoperative 15 min and after the surgery in the observation group were significantly higher than those in the control group (both P < 0.05). In the observation group, the dosage of remifentanil and propofol were (1.0±0.4) mg and (299±40) mg, significantly lower than (1.3±0.6) mg and (365±42) mg in the control group (both P < 0.05). The incidence of complications did not significantly differ between two groups (P > 0.05). In the observation group, the VAS scores at 2-, 6- and 12-h after operation were remarkably lower than those in the control group (all P < 0.01). The respiratory recovery time, eye opening time, directional force recovery time and extubation time of the recipients in the observation group were significantly shorter than those in the control group (all P < 0.05). The expression levels of including interleukin (IL)-1, IL-6 and tumor necrosis factor-α (TNF-α) at postoperative 1 d in the observation group were considerably lower than those in the control group (all P < 0.05).
      Conclusions  Retrobulbar nerve block combined with general anesthesia can maintain hemodynamic stability during PKP, reduce the dosage of remifentanil and propofol and alleviate the degree of postoperative pain and inflammatory responses of the recipients.

     

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