论著

可弯曲喉罩在经鼻内镜眼科日间手术中的应用观察

Application of flexible laryngeal mask in endoscopic ophthalmic day surgery

:547-553
 
目的:探究可弯曲喉罩在经鼻内镜眼科日间手术中应用的安全性。方法:收集2023年1月—2024年1月在全身麻醉(全麻)下行经鼻内镜眼科日间手术成年患者资料,分析可弯曲喉罩使用的成功率,观察患者入室时、插管后、手术开始时、手术结束时的血流动力学变化情况;并记录喉罩置入后、手术开始5 min、手术开始30 min和手术结束时的呼吸参数及患者在PACU的停留期间的并发症。结果:共635例患者纳入分析,其中619例患者选用喉罩,607例患者喉罩置入成功,成功率98.1%,喉罩置入失败12例,均为诱导期间置入失败,占1.9%,无术中发生喉罩通气失败改气管插管病例。喉罩通气能满足经鼻内镜手术需求,表现为各时点通气量无显著变化及平稳的心率和平均动脉压。患者均顺利复苏,PACU停留时间为(34.6±11.2) min,喉罩拔除时间为(14.3±4.3) min,无二次气管内插管事件发生。结论:置入成功的可弯曲喉罩可安全应用在经鼻内镜眼科日间全麻手术中。
Objective: To investigate the safety of flexible laryngeal masks in the application of endoscopic ophthalmic ambulatory surgery. Methods: Data of adult patients undergoing endoscopic day ophthalmic surgery under general anesthesia from January 2023 to January 2024 were collected; the changes in hemodynamics at T1 (entry into the operating room), T2 (after intubation), T3 (before surgery), and T6 (after surgery) time points and the respiratory parameters at T2 (after intubation), T4 (5 minutes after surgery), T5 (30 minutes after surgery), and T6 (after surgery) time points were analyzed; meanwhile, the complications during the PACU stay were also analyzed. Results: A total of 635 patients were included in the retrospective analysis, of whom 619 patients were initially used FLMA, FLMA were successfully inserted in 607 patients with a rate of 98.1% while 12 patients suffered insertion failure during the period of anesthesia induction. Importantly, none of patients displayed FLMA ventilation failure and required tracheal intubation during the period of surgery. General anesthesia via FLMA ventilation can provide high quality of surgical field for endoscopic ophthalmic surgery, as evidenced by stable heart rates and mean arterial pressure and no significant change in minute ventilation at each time points. All patients recovered uneventfully with a PACU stay time of 34.6±11.2min and FLMA removal time of 14.3±4.3 min. None of patients exhibited subsequently endotracheal intubation after FLMA removal. Conclusion: FLMA with successful placement can be safely used for endoscopic ophthalmic ambulatory surgery under general anesthesia.
论著

全身麻醉在青光眼日间手术中的应用分析

The application of general anesthesia in the ambulatory glaucoma surgery

:541-546
 
目的:分析全身麻醉在青光眼日间手术中的应用特点。方法:回顾性收集2023年1月—6月于中山大学中山眼科中心在全身麻醉下接受青光眼日间手术患者71例(全麻组),并选择同时期在局部麻醉下接受青光眼手术患者154例(局麻组),同时以年龄为配对因素行倾向评分匹配分析。主要观察指标为患者术后离院时间,并对患者的手术时间、手术前后眼压、视力、中央前房深度、周边前房深度、甘露醇使用情况以及术后较术前眼压降低差值进行分析。结果:与局麻组比较,全麻组患者术后离院时间未有延长(P>0.05);全麻组患者术前眼压较高(P<0.001)、中央前房深度浅(P=0.018)、周边前房深度浅(P<0.001);且全麻组患者在术后较术前眼压降低差值更大(P=0.002)。组间术后中央前房深度、术后使用甘露醇者比例及术后视力提高者比例比较差异均无统计学意义(P>0.05)。结论:术前眼部条件较差的青光眼患者能在全身麻醉下完成日间手术,且不延长术后离院时间。
Objective: To analyze the application of general anesthesia in the ambulatory glaucoma surgery. Methods: This retrospective study collected 71 patients who underwent ambulatory glaucoma surgery withgeneral anesthesia at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2023 to June 2023, and 154 patients who underwent similar glaucoma surgery with local anesthesia during the same period. Age differences between the two groups were balanced by propensity score-matched analysis. The main outcome measures were the patient's post-operative discharge time, and the secondary end points included the duration of surgery, the patients' preoperative and postoperative intraocular pressure (IOP), visual acuity status, central anterior chamber depth, peripheral anterior chamber depth, mannitol use, the difference in IOP reduction after surgery compared to preoperative. Results: After propensity score-matched analysis, as compared with group L, general anesthesia did not prolong the patient's post-operative discharge time(P>0.05).Patients in the group G displayed significant higher IOP (P<0.001), shallower central anterior chamber depth (P=0.018), and shallower peripheral anterior depth (P<0.001). The dramatic reductions in IOP after surgery were exhibited in group G as compared with group L(P=0.002). There were no statistically significant differences in postoperative central anterior chamber depth, incidences in postoperative mannitol use, as well as incidences in visual acuity improvement on the first day after surgery. Conclusion: Glaucoma patients with poor preoperative ocular conditions were able to complete the complex glaucoma surgery under general anesthesia without prolonging their post-operative discharge time.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
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