目的：观察表面麻醉下不同吸氧方式对白内障超声乳化手术患者生命体征变化的影响，探讨适宜的超声乳化手术中吸氧的方式。方法：选取2020年4月至2020年9月于中山大学中山眼科中心行白内障超声乳化摘除术的患者291例，随机分成3组，分别为简易面罩吸氧组(面罩组)97例、鼻导管吸氧(鼻导管组)97例、无吸氧组(对照组)97例，其中面罩组和鼻导管组的吸氧流量均为氧流量2~4 L/min。监测患者进入手术室时(T0)、手术开始时(T1)以及手术结束时(T2)的血压、心率以及血氧饱和度(SpO2)。结果：三组患者在进入手术间时生命体征差异无统计学意义，三组患者术中 血压变化不显著(P>0.05)。在T2时点，氧气吸入的患者其SpO2高于对照组(P<0.05)，但均在正常范围内。结论：表面麻醉下白内障超声乳化手术的患者在无严重基础疾病的情况下，术中适当吸氧及监测血流动力学可以增加患者的舒适度及临床安全，对患者使用的吸氧方式应以不影响术中操 作及患者舒适度的方式。
Objective: To observe the effects of different oxygen inhalation methods on the changes of vital signs in adult patients undergoing phacoemulsification under topical anesthesia, and to explore the appropriate oxygen inhalation methods in phacoemulsification. Methods: A total of 291 patients who underwent phacoemulsification for cataract extraction in Zhongshan Ophthalmic Center, Sun Yat-sen University from April 2020 to September 2020 were randomly divided into 3 groups: the simple mask oxygen inhalation group (n=97), the nasal catheter oxygen inhalation group (n=97), and the oxygen-free group (n=97). The oxygen flow of the mask group and the nasal catheter group was 2–4 L/min. Blood pressure, heart rate, and oxygen saturation (SpO2) were monitored at entry into the operating room (T0), at the beginning of surgery (T1), and at the end of surgery (T2). Results: There was no significant difference in vital signs among the 3 groups when entering the operating room, and no significant change in intraoperative blood pressure among the 3 groups (P>0.05). At T2, the blood oxygen saturation of patients with oxygen inhalation was higher than that of the oxygen-free group (P<0.05), but within the normal range. Conclusion: For cataract phacoemulsification patients under topical anesthesia without serious comorbidities, appropriate oxygen inhalation and monitoring hemodynamics can increase the comfort and safety of patients, and oxygen inhalation should be used without affecting surgery manipulation and comfort of patient.
目的：探索局部麻醉辅助小剂量丙泊酚联合瑞芬太尼镇静镇痛在成人斜视矫正术中的应用效果。方法：本研究为前瞻性队列研究，选取2020年10月1日至2021年5月31日于北京同仁医院行斜视矫正术的成年患者24例，单纯局部麻醉组、镇静镇痛组各12例。所有患者均应用2%利多卡因10 mL+0.1% 肾上腺素0.1 mL混合液进行眼部局部浸润注射，静脉滴注昂丹司琼8 mg。镇静镇痛组患者静脉滴注咪达唑仑1 mg、舒芬太尼5 μg，继之以丙泊酚0.6~3 mg/(kg·h)、瑞芬太尼0.01~0.05 μg/(kg·min)持续输注，使Ramsay镇静分级维持在II级。记录两组患者术中视觉模拟评分(visual analog scale，VAS)、脑电双频指数(bispectral index，BIS)、术者满意度评分及调节眼位配合度评分，术中恶心呕吐、眼心反射、呼吸抑制、血压心率等情况，以及丙泊酚、瑞芬太尼输注速度。结果：镇静镇痛组患者丙泊酚持续输注速度为0.6~1.8 mg/(kg·h)，瑞芬太尼持续输注速度为0.01~0.03 μg/(kg·min)。镇静镇痛组患者 术中VAS、BIS、心率增快发生率均低于单纯局部麻醉组(P<0.05)，术者满意度评分、血压下降发生率均高于单纯局部麻醉组(P<0.05)；两组患者术中恶心呕吐、眼心反射、呼吸抑制、血压升高发生率及调节眼位配合度评分差异均无统计学意义(P>0.05)。结论：在成人斜视矫正术中，局部麻醉辅 助小剂量丙泊酚联合瑞芬太尼镇静镇痛可有效减轻患者术中疼痛，作用安全可靠。
Objective: To explore the effect of local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil in adult strabismus surgery. Methods: This study was a prospective cohort study. Twenty-four adult patients who underwent strabismus surgery in Beijing Tongren Hospital from October 1, 2020 to May 31, 2021 were selected and divided into local anesthesia group, and sedation and analgesia group, eachwith 12 patients. All patients received local anesthesia with a mixture of 2% lidocaine 10 mL and 0.1% epinephrine 0.1 mL, and intravenous ondansetron 8 mg. Patients in the sedation and analgesia group received intravenous infusion of midazolam 1mg and sufentanil 5 μg, followed by continuous infusion of propofol 0.6–3 mg/(kg·h) and remifentanil 0.01~0.05 μg/(kg·min) to maintain Ramsay sedation score at grade II. Visual Analogue Scale (VAS), bispectral index (BIS), operator’s satisfaction score, patient’s coordination score, nausea and vomiting, oculocardiac reflex, respiratory depression, blood pressure, heart rate and the infusion rate of propofol and remifentanil during operation were recorded in these two groups. Results: In the sedative and analgesic group, the infusion rates of propofol and remifentanil were 0.6–1.8 mg/(kg·h) and 0.01–0.03 μg/(kg·min), respectively. VAS, BIS and the incidence of increased heart rate in the sedation and analgesia group were lower than those in the local anesthesia group (P<0.05); operator’s satisfaction score and the incidence of decreased blood pressure in the sedation and analgesia group were higher than those in the local anesthesia group (P<0.05); there was no significant difference in the incidence of intraoperative nausea and vomiting, oculocardiac reflex, respiratory depression, elevated blood pressure and patient’s coordination score between the two groups (P>0.05). Conclusion: In adult strabismus surgery, local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil can effectively relieve intraoperative pain, which is safe and reliable.
目的：对比喉罩与气管插管在小儿眼科全身麻醉中的应用情况，选取小儿全身麻醉的适宜气道管理方式。方法：选取2019年6月至2021年4月在天津市眼科医院进行眼科全身麻醉手术的86例患儿为研究对象，根据全身麻醉诱导后置入气管导管或喉罩分为插管组与喉罩组，每组43例。麻醉诱导后插入气管导管或喉罩后实施容量控制通气。通过回顾收集麻醉记录单查询麻醉诱导前(T0)、麻醉诱导后(T1)、插入气管导管或喉罩时(T2)、手术开始时(T3)、手术结束时(T4)、移除喉罩或气管导管时(T5)检测心率、平均动脉压，以及插管后5、10、20 min时的平均气道压和呼气末CO2分压。根据麻醉记录单查询每例患者气管插管或喉罩置入的次数、苏醒期呛咳及躁动的发生情况。比较2组麻醉时间、置管/喉罩首次成功率、拔管/撤罩时间、自主呼吸恢复时间、麻醉复苏时间。观察2组患者并发症(呛咳、躁动发生情况)的发生情况。结果：在T2、T3和T5时，插管组心率明显高于喉罩组，差异有统计学意义(P<0.05)；在T2、T3、T4和T5时，插管组平均动脉压明显高于喉罩组，差异有统计学意义(P<0.05)。插管后5、10和20 min时，插管组平均气道压均高于喉罩组，差异有统计学意义(P<0.05)。2组不同时间点呼气末CO2分压的比较，差异无统计学意义(P<0.05)。喉罩组麻醉复苏期间呛咳和躁动的发生率明显低于插管组，差异有统计学意义(P<0.05)。结论：喉罩具有操作简单、对气道刺激较小等优点，用于小儿眼科全身麻醉时对血流动力学的影响较小，气道反应性低，并发症较少，值得在临床推广使用。
Objective: To select the appropriate airway management mode for children under general anesthesia by comparing the application of laryngeal mask and endotracheal intubation in pediatric ophthalmology. Methods: A total of 86 children who underwent ophthalmic general anesthesia surgery in our hospital in June 2019 and April 2021 were selected as the study subjects, and the tracheal catheter or laryngeal mask was placed after induction of general nesthesia, and the group of 43 cases were divided into intubation group and laryngeal mask group. Volumecontrolled ventilation is performed after induction of anesthesia after insertion of a tracheal catheter or laryngeal mask. Heart rate and mean arterial pressure were detected by retrospectively collecting anesthesia records alone before anesthesia induction (T0), after anesthesia induction (T1), when a tracheal catheter or laryngeal mask was inserted (T2), at the beginning of surgery (T3), at the end of surgery (T4), and when the laryngeal mask or tracheal catheter was removed (T5). As well as the average airway pressure and end-expiratory CO2 partial pressure at 5, 10, and 20 min after intubation. The number of endotracheal intubations or laryngeal hoods, the occurrence of cough during awakening, and agitation in each patient was queried according to the anesthesia record. The timing of anesthesia, the first success rate of catheterization/laryngeal mask, the time of extubation/uncommissioning, the time of spontaneous breathing recovery, and the time of anesthesia resuscitation were compared between the 2 groups. The occurrence of complications (choking cough, agitation) in both groups of patients was observed. Results: At T2, T3 and T5, the heart rate in the intubation group was significantly higher than that in the laryngeal mask group (P<0.05), and at T2, T3, T4 and T5, the mean arterial pressure in the intubation group was significantly higher than that in the laryngeal mask group(P<0.05). At 5, 10, and 20 min after intubation, the mean airway pressure in the intubation group was higher than that in the laryngeal mask group, and the difference was statistically significant (P<0.05). There was no statistical difference in the partial pressure of CO2 at the end of expiratory breath at different time points between the 2 groups (P<0.05). The incidence of choking cough and agitation during anesthesia resuscitation in the laryngeal mask group was significantly lower than that in the intubation group, and the difference was statistically significant (P<0.05). Conclusion: The laryngeal mask has the advantages of simple operation and less stimulation of the airway, and when used for pediatric ophthalmic general anesthesia, it has less hemodynamic effect, low airway responsiveness and fewer complications, and is worth promoting in clinical practice
目的：观察喉罩通气吸入七氟醚麻醉在小儿眼底荧光素造影检查(fundus fluorescein angiography，FFA)期间眼位情况、眼球运动的发生率和丙泊酚调整眼位的有效率。方法：回顾性分析2018年6月至2019年12月七氟醚麻醉下接受FFA的儿童的病例资料，记录检查开始时眼位分级、检查中眼球运动发生率、丙泊酚调整眼位的有效率、麻醉后恢复自主活动时间以及不良事件。结果：纳入1~9岁患儿54例，检查开始时42.6%(23/54)的患者眼位1级，51.9%(28/54)的患者眼位2级，5.6%(3/54)的患者眼位3级，检查中眼球运动发生率为61.1%(33/54)。13%(7/54)的患儿需丙泊酚干预，丙泊酚1 mg/kg纠正眼位的有效率为100%。患儿麻醉后恢复正常活动的平均时间为24.4 min，未发生不良事件。结论：喉罩复合七氟醚的麻醉可为门诊小儿眼底荧光造影提供相对满意的麻醉质量，患者在麻醉后可迅速恢复日常活动，丙泊酚可迅速纠正检查中眼位不正。
Objective: To observe the eye position, the incidence of eye movement and the efficacy of propofol on correcting eccentric eyeball position in children undergoing examination of outpatient fundus fluorescein angiography (FFA) with inhaled sevoflurane via laryngeal mask airway. Methods: Children undergoing FFA with sevoflurane anesthesia from June 2018 to December 2019 were retrospectively reviewed. Eye position at the beginning of examination, incidence of eye movement during examination, the efficiency of propofol on correcting eccentric eyeball position during procedure, the time to resume normal activities, and adverse events were recorded. Results: Fifty-four children aged 1–9 years were included in this study. The rates of eye position from grade one to grade three at the beginning of examination were 42.6% (23/54), 51.9% (28/54), and 5.6% (3/54), respectively. The incidence of eye movement during examination was 61.1% (33/54). 13% (7/54) of children with unsatisfactory eye-position needed intervention with propofol. The efficacy of propofol (1 mg/kg) in correcting eye position was 100%. The mean time to return normal activities was 24.4 min. There were no any adverse events during the peri-anesthetic period. Conclusion: Inhaled sevoflurane via LMA can provide appropriate anesthesia for outpatient FFA in children. Children can resume daily activities soon after anesthesia. Propofol can return the incorrect eye position during examination
小儿眼科麻醉的挑战是既要保障患儿的麻醉安全又要提高手术接台效率。麻醉前的充分评估和详细的准备可以有效地降低麻醉期间的并发症。在麻醉前访视期间，需要做到仔细地询问病史，全面的麻醉体格检查及必要的实验室检查或专科会诊，完成充分告知任务，从而提高小儿眼科麻醉安全性。
The challenge of pediatric ophthalmic anesthesia is how to balance the safety and efficiency of ophthalmic surgery. Careful pre-operative evaluation and preparation can effectively reduce potential complications during pediatric ophthalmic anesthesia. During the preoperative assessment, it’s necessary to gather information, perform a full physical examination, take required laboratory tests or consultations with specialties, and deliver appropriate information and consent to increase the safety of pediatric ophthalmic anesthesia
