目的：探讨全身麻醉诱导期应用不同种类的非去极化肌松药罗库溴铵、顺式阿曲库铵和米库氯铵对眼压升高的青光眼患者眼内压的影响。方法：将术侧眼眼压>21mmHg青光眼手术患者随机分配到罗库溴铵组、顺式阿曲库铵组和米库氯铵组。靶控输注丙泊酚至患者脑电双频指数(bispectral index，BIS)低于55后，根据组别分别静注0.6mg/kg罗库溴铵、0.1mg/kg顺式阿曲库铵及0.2mg/kg米库氯铵，待4个成串刺激(train of four stimulation，TOF)比值降至0后置入可弯曲喉罩，随后行机械通气并给予芬太尼1.5~2.0μg/kg，2%~3%七氟烷吸入维持麻醉。分别于麻醉诱导前(T0)、镇静后(T1)、肌松后(T2)及喉罩置入后(T3)测量三组青光眼患者术侧眼眼压并记录上述时间点血流动力学参数。结果：罗库溴铵组、顺式阿曲库铵组、米库氯铵组患者的眼压在T1、T2、T3时间点均较T0显著下降，差异有统计学意义(均P<0.001)；三组患者T2时间点眼压与T1相比差异均无统计学意义(P=0.337，P=0.520，P=0.062)；三组患者给予肌松药前后的眼压差值(T2–T1)分别为(0.68±4.39)、(0.36±3.72)和(1.27±3.91)mmHg，组间比较差异无统计学意义(P=0.353)。结论：非去极化肌松药罗库溴铵、顺式阿曲库铵及米库氯铵对眼压升高的青光眼患者的眼压无明显影响，且3种肌松药之间未见显著差异。

Objective: To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia. Methods: Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group, cis-atracurium group and mivacurium group. After target controlled infusion of propofol until the bispectral index (BIS) lower than 55, 0.6 mg/kg rocuronium, 0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups. The flexible laryngeal mask was placed after the train-of-four stimulation (TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately. General anesthesia was maintained by 1.5–2.0 μg/kg fentanyl and 2%– 3% sevoflurane. Intraocular pressure and hemodynamic parameters were measured before anesthesia induction (T0), after sedation (T1), after muscle relaxation (T2), and after laryngeal mask insertion (T3). Results: The intraocular pressure of patients in rocuronium group, cis-atracurium group and mivacurium group at T1, T2, T3 were lower than baseline (T0), and the difference was statistically significant (P<0.001); There was no significant difference in intraocular pressure at T2 compared with T1 in rocuronium group, cis-atracurium group and mivacurium group (P=0.337, P=0.520 and P=0.062 respectively); The difference of intraocular pressure between T2 and T1 in rocuronium group, cis-atracurium group and mivacurium group were (0.68±4.39), (0.36±3.72) and (1.27±3.91) mmHg respectively and there was no significant difference among the groups (P=0.353). Conclusion: The non-depolarizing muscle relaxants rocuronium, cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure, and there is no significant difference among the three muscle relaxants.

目的：在麻醉监测管理(monitored anesthesia care，MAC)中，通过与咪唑安定比较，观察右美托咪 定在玻璃体视网膜手术中应用的效果、安全性，探讨其应用可行性。方法：将择期玻璃体视网膜 手术患者40例随机双盲分入咪唑安定组(M组)和右美托咪定组(D组)。每组20例，两组患者均行球 后神经阻滞麻醉，连接脑电双频指数(bispectral index，BIS)监测仪监测并维持BIS值在70~90间， 观察和比较麻醉手术中及复苏期的平均动脉压(mean arterial pressure，MAP)、心率(heart rate， HR)、呼吸频率(respiratory rate，RR)、脉搏氧饱和度(oxygen saturation，SpO2)、Ramsay镇静评 分、疼痛数字评分法(Numerical Rating Scale，NRS疼痛评分)、手术医生和患者麻醉效果评分及不 良反应的差异。结果：与麻醉前比较，手术期D组用药后10 min内的心率、血压下降差异有统计学 意义(P<0.05)，且用药后10 min内D组心率下降幅度较M组更大(P<0.05)。在手术期和复苏期，D组 的NRS疼痛评分均显著低于M组且差异有统计学意义(均P<0.001)，而两组的Ramsay镇静评分差异 无统计学意义(P>0.05)。D组手术期患者的体动发生率和羟考酮使用率显著低于M组(均P<0.05)。 手术医生和患者的麻醉效果评分D组显著高于M组(均P<0.001)。结论：右美托咪定用于玻璃体视 网膜手术，较咪唑安定镇痛效果好且不良反应少，麻醉效果更好。

Objective: The aim of this study was to compare the efficacy and safety of dexmedetomidine versus midazolam for the monitored anesthesia care (MAC) management of patients undergoing vitreoretinal surgery. Methods: Forty patients undergoing selective vitreoretinal surgery were double-blind and randomly dividedinto midazolam group (group M) and dexmedetomidine group (group D), each group had 20 patients. Patients in both groups were anesthetized with posterior bulbous nerve block. Bispectral index (BIS) monitor was connected and the BIS value was maintained between 70 and 90. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), Ramsay sedation score, numerical rating scale (NRS), surgeon’s and patient’s anesthesia effect score and adverse reactions were recorded during anesthesia and recovery period. Results: Compared with the data of pre-anesthesia, there were statistical differences of the decrease of HR and MAP in group D within the 10 minutes after medication (P<0.05), and the decrease of HR in group D was greater than that in group M (P<0.05). The NRS pain score in group D was significantly lower than that in group M with statistical significance (P<0.001) during the operation and resuscitation, while there was no significant difference in Ramsay sedation score between the two groups during the operation and resuscitation (P>0.05). In terms of adverse reactions to anesthesia, the incidence of spontaneous movement and oxycodone utilization in group D were significantly lower than those in group M (P<0.05). The anesthesia effect scores of surgeons and patients in group D were significantly higher than those in group M (all P<0.001). Conclusion: Dexmedetomidine has better analgesic effect and less adverse reactions than midazolam in vitreoretinal surgery.

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：了解重度视力损伤和盲患者居家的主要护理问题及护理需求的内容，为医护人员制订居家照护支持计划提供依据。方法：采用描述性质性研究方法，于2020年4至9月对在广州市某三甲眼科专科医院的20例重度视力损伤和盲的住院患者进行面对面的半结构式访谈，采用归纳式内容分析法对访谈资料进行分析。结果：重度视力损伤和盲患者居家的主要护理问题有日常生活自理的能力缺失、外出社交活动受限和难以适应家庭角色的改变；护理需求包括希望医院提供多维度的疾病相关知识和提供多渠道的医疗咨询服务。结论：重度视力损伤和盲患者居家照护存在诸多的护理问题及需求，患者希望得到多维度相关知识和多渠道医疗咨询，医院、社区应该高度重视此类患者，同时给予相应的指导和帮助，从而提高患者的居家生活质量。

Objective: To explore the main nursing problems and demands of patients with severe visual impairment or blindness, so as to provide the basis for health staff to formulate home care support plans of high quality. Methods: By using a descriptive qualitative method, face-to-face semi-structured interviews were conducted among 20 patients with severe visual impairment or blindness who were hospitalized in the top-grade ophthalmic hospital in Guangzhou from April to September 2020. The inductive content analysis method was used to analyze the data. Results: The main nursing problems of these patients were the lack of self-care ability, limited social activities, and difficulty in adapting to changes in family roles. Nursing needs include the hope that hospitals can provide multidimensional disease-related knowledge and multi-channel medical consulting services. Conclusion: Patients with severe visual impairment or blindness have many problems and needs in home care. They would like to obtain multi-dimensional knowledge and receive multi-channel medical consultation. Health staff from hospitals and communities should attach great importance to these patients, as well as provide appropriate guidance and assistance, so as to improve their activities of daily living.