近年来，眼科手术后的疼痛受到关注，部分患者术后表现出疼痛区域扩大，神经性畏光。术后这种 对伤害性刺激性信号反常性增加的现象称之为痛觉过敏。痛觉过敏的发展会导致患者延迟术后恢 复等问题。此外，痛觉过敏还会引起患者不适，诱使患者使用更多的止痛药而产生相关的不良反 应。而TRPV1/TRPA1是一种伤害性感受器，能够被伤害性刺激特异性激活而诱发痛觉过敏。尽管 如此，目前关于眼科术后的痛觉过敏发病机制未完全阐明，TRPV1如何增敏导致痛觉过敏的分子生 物学过程尚未明确。

The postoperative pain of ophthalmic surgery has been widely concerned in recent years. Some patients show enlarged painful areas and neurophotophobia postoperatively. This abnormal increase in noxious irritant signals after surgery is called hyperalgesia. The development of hyperalgesia can result in delayed postoperative recovery for patients. In addition, hyperalgesia can also cause discomfort for patients, and induce patients to use more analgesics, which can have related side effects. TRPV1/TRPA1 is a nociceptor, which can be specifically activated by nociceptive stimuli to induce hyperalgesia. Nevertheless, the pathogenesis of hyperalgesia after ophthalmology surgery has not been fully elucidated, and the molecular signal pathway of how TRPV1 sensitizes and causes hyperalgesia is not yet clear. 

目的：探讨构建眼科高值手术耗材管理体系的思路和具体实践方法，加强眼科高值手术室耗材管理。方法：通过信息化手段，建立眼科高值手术耗材可视化管理系统，与医院各信息系统对接，整合相关数据，建立眼科高值手术耗材合理使用监测系统，将耗材的供应、使用到监测的全生命周期管理与日常监管相结合。结果：通过对眼科高值手术耗材全生命周期体系的建立，实现了术前可控制、术中可监测、术后可追溯的全流程管理。结论：该体系的建立可提高眼科手术高值耗材的管理效率及质量。

Objective: To construct an ideal and practical method for managing ophthalmic high-value surgical supplies to strengthen the management of ophthalmic operating room. Methods: A visual management system of ophthalmic high-value surgical supplies was established by using information technology connected with hospital information systems, then the data were integrated to construct a monitoring system for real-time status of ophthalmic high-value surgical supplies, including the whole life cycle management of the surgical supplies. Results: Through the establishment of the system for whole life cycle of high-value ophthalmic surgical supplies, the whole process management realized the supplies for preoperative control, intraoperative monitoring and postoperative trace. Conclusion: Constructing the system solves the daily management problem of ophthalmic high-value surgical supplies, reduces the blind area of management, and strengthens the supervision of surgical supplies in the ophthalmic operating room.

目的：评估右美托咪定复合舒芬太尼用于老年青光眼患者经巩膜二极管激光睫状体光凝术 (transscleral diode laser cyclophotocoagulation，TDLC)术后自控静脉镇痛(patient-controlled intravenous analgesia，PCIA)的安全性和有效性。方法：选择行TDLC术老年青光眼患者80例，采用随机数字表法将患者分为SD组(n=40)和S组(n=40)。SD组术后PCIA采用舒芬太尼1.5μg/kg+右美托咪定1.5 μg/kg+托烷司琼4mg；S组采用舒芬太尼2μg/kg+托烷司琼4mg。将相应药物置入生理盐水配成100mL混合液加入电子镇痛泵，手术结束即刻行PCIA至术后24h。观察比较两组患者基本情况和手术情况，比较术前(T0)、术后即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者的收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、心率(heart rate，HR)、NRS疼痛评分、Ramsay镇静评分及非手术眼的眼内压(intraocular pressure，IOP)，比较术后恶心呕吐、呼吸抑制、躁动等不良反应及使用其他辅助镇痛药物的情况。结果：两组患者基本情况和手术情况的差异无统计学意义。两组各时点DBP、非手术眼IOP及NRS评分差异无统计学意义。SD组T3、T4时点SBP，T2、T3、T4时点HR以及T2、T3时点Ramsay评分均低于S组，差异有统计学意义(P<0.05)。两组患者发生不良反应的总例数差异无统计学意义，但SD组恶心呕吐(1例)和烦躁(2例)发生率均低于S组(分别为6例和9例)，差异有统计学意义(P<0.05)。两组患者呼吸抑制和眩晕嗜睡发生率以及使用其他辅助镇痛药物例数差别无统计学意义，SD组舒芬太尼使用量低于S组(P<0.05)。结论：采用右美托咪定1.5μg/kg复合舒芬太尼1.5μg/kg行PCIA时不影响非手术眼IOP，可安全有效地应用于老年青光眼患者TDLC术后镇痛。

Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC

目的：探讨“破窗理论”在手术室护理安全管理中的应用，为构建手术期间质量安全保障体系提 供新的管理依据。方法：于2019年2月至2020年6月组织佛山市三水区人民医院手术室医护人员对 “破窗理论”进行学习，调查分析护理质量、护理满意度以及手术室护理中出现的安全问题，进 而分析“破窗理论”在手术室护理安全管理中的应用效果。结果：实施前不安全事件发生率高于 实施后(16.00% vs 4.00%，P<0.05)。实施后手术室护理安全管理、药物使用规范性、感染控制程 度、基础护理质量评分高于实施前(P<0.05)。与实施前相比，实施后手术医生、医护人员、患者 满意度明显上升(P<0.05)。结论：“破窗理论”在传统护理的基础上提供了一种更为积极的干预 模式，其在护理安全管理中的应用值得进一步推广应用。

Objective: To provide a new management system to increase the quality and safety during the operation through applicating the broken window theory in the operating room nursing quality management. Methods: From February 2019 to June 2020, we organized medical staff in the operating room to study the broken window theory, investigated the nursing quality, nursing satisfaction and safety problems in operating room nursing, and then analyze the application effect of the theory in the nursing safety management. Results: The incidence of unsafe events before implementation of the broken window theory were significantly higher than that after the implementation (16.0% vs 4.0%, P<0.05). After the implementation, the scores of nursing safety management, standardized drug use, infection control and basic nursing quality in the operating room were higher than those before the implementation (P<0.05). The satisfaction of surgeons, medical staff and patients increased significantly after implementation as compared with before implementation (P<0.05). Conclusion: The broken window theory effectively provides a more active intervention model than traditional care, and it deserves further application in nursing safety management.

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：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：基于新一代Corvis^® ST分析成人近视患者经飞秒激光小切口角膜透镜取出术(small incision corneal lens extraction，SMILE)后角膜体(corneal volumn，CV)的变化与角膜生物力学变化的相关性，进一步证明C V对于评估SMILE术后角膜生物力学特性以及预测屈光手术结果的价值。方法：采用前瞻性病例观察研究方法，纳入2021年1月至8月在佛山市第二人民医院拟行SMILE的成人近视患者72例(72眼)。为避免双眼相关性，纳入患者的一个合适眼(右眼或者左眼)，根据术前中央角膜厚度，将厚度470~<530 μm分为低角膜厚度组，530~<560 μm为中角膜厚度组 ， ≥560μm为高角膜厚度组。应用新一代 Corvis^® ST 于术前和术后3个月测量非接触生物力学校正眼压(biomechanical intraocular pressure，bIOP)、2 mm处变形幅度的比值[DA ratiomax(2 mm)，DA2ratio]、综合半径(integrated inverse concave radius，IR)、水平方向Ambr?sio相关厚度，最薄点厚度/厚度变化率(Ambrósio’s relational thickness，ARTh)、第1次压平时角膜硬度参数(stiffness parameter applanation 1，SP-A1)、Corvis生物力学指数(Corvis biomechanical index，CBI)和应力和应变参数(stress-strain index，SSI)7项角膜生物力学参数。应用Pentacam眼前节分析系统测量中央角膜厚度(central corneal thickness，CCT)和不同区域的CV(CV_3mm、CV_5mm、CV_7mm和CV_10mm)。对比SMILE术前与术后3个月的CV、角膜生物力学参数的变化，并分析角膜生物力学参数与CV的相关性。数据采用配对、独立样本t检验分析差异性；单因素方差分析不同角膜厚度组的差异性；Spearman相关性分析和偏最小二乘回归(partial least squares linear regression，PLSLR)分析相关性。结果：SMILE术后3个月，CV_3mm、CV_5mm、CV_7mm和CV_10mm均较术前显著下降(均P<0.001)；bIOP、ARTh、SP-A1和SSI较术前明显下降(P<0.05)；DA2ratio、IR和CBI较术前明显升高(P<0.05)。术前和术后3个月不同角膜厚度组的ARTh、SP-A1DA2ratio、IR和CBI差异均有统计学意义(均P<0.05)，低中角膜厚度组SSI术前后变化不大(P>0.05)。术前DA2ratio与CV_3mm、CV_5mm呈负相关，与CV_10mm呈正相关；ARTh与CV_3mm、CV_5mm呈正相关，与CV_10mm呈负相关；bIOP与CV_10mm呈正相关；IR与CV_3mm、CV_5mm呈负相关，与CV_10mm呈正相关；SP-A1与CV_3mm、CV_5mm呈正相关，与CV_10mm呈负相关；CBI与CV_3mm、CV_5mm和CV_10mm呈负相关，SSI与CV_3mm呈正相关，与CV_10mm呈负相关。SMILE术后3个月，ARTh与CV_3mm、CV_5mm呈正相关，与CV_10mm呈负相关；CBI与CV_3mm负相关、CV_10mm呈正相关(均P<0.05)。SMILE术后3个月变化量中，ARTh与CV_3mm、CV_5mm呈正相关，与CV_10mm负相关；CBI与CV_3mm呈负相关，与CV_10mm呈正相关(均P<0.05)。结论：成人SMILE术后3个月CV_3mm、CV_5mm、CV_7mm、CV_10mm、眼压和CCT较术前均显著降低；越往周边区域CV减少量越多。SMILE术后3个月的新一代Corvis^® ST角膜生物力学新型参数较术前有显著变化；不同区域CV与角膜生物力学参数存在一定的相关性，预期SMILE术后不同区域的CV可以表征术后部分角膜生物力学特性的改变，CV可能成为表征预测角膜扩张发展的参数因素。

Objective: To evaluate the changes in corneal volume (CV) and the correlation of corneal biomechanics in adult myopic patients after small incision corneal lens extraction (SMILE) based on the new generation of Corvis^® ST.This paper further demonstrates the value of CV in evaluating corneal biomechanical properties after SMILE and predicting the outcome of refractive surgery. Methods: A total of 72 cases (72 eyes) of adult myopia who were scheduled for SMILE in The Second People’s Hospital of Foshan from January to August 2021 were included in this prospective observational case study. To avoid binocular correlation, a suitable eye for each person was selected for inclusion. Based on the preoperative central corneal thickness (CCT), the cases were divided into a low corneal thickness group (470–<530 μm), a medium corneal thickness group (530–<560 μm), and a high corneal thickness group (≥560 μm). The biomechanical intraocular pressure (bIOP), DA ratiomax (2 mm) (DA2ratio), integrated inverse concave radius (IR), Ambrósio’s relational thickness (ARTh), stiffness parameter applanation 1 (SP-A1),corvis biomechanical index (CBI) and stress-strain index (SSI) were measured by Corvis^® ST. The Pentacam anterior segment analysis system was used to measure partial CV and total CV with a diameter of 3, 5, and 7 mm from the top of the cornea, with an assumed diameter of 10 mm. The changes in corneal biomechanical parameters and CV before SMILE and 3 months after SMILE were compared. The correlation between corneal biomechanical parameters and CV was studied. Data were analyzed by paired and independent sample t-tests. One-way analysis of variance (ANOVA) was used to assess the differences between the corneal thickness groups. Spearman correlation analysis and partial least squares linear regression (PLSLR) were used for correlation analyses. Results: Three months after SMILE, the CV in different areas (CV_3mm, CV_5mm, CV_7mm, and CV_10mm) were significantly lower than those before SMILE, and the differences were statistically significant (all P<0.001). The corneal biomechanical parameters bIOP, ARTh, SP-A1, and SSI were significantly decreased compared with those before the operation (P<0.05). In contrast, the DA2 ratio, IR, and CBI were significantly higher than those before the operation (P<0.05). A comparison of the corneal biomechanical parameters ARTh, SP-A1, DA2 ratio, IR, and CBI in the different corneal thickness groups before and after SMILE showed overall differences among the groups (P<0.05).However, there was no significant change in the SSI between the low and medium corneal thickness groups. The correlation of the preoperative baseline DA2ratio was negatively correlated with CV_3mm and CV_5mm, and positively correlated with CV_10mm; Conversely, ARTh was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; BIOP was positively correlated with CV_10mm; IR was negatively correlated with CV_3mm and CV_5mm, and positively correlated with CV_10mm; SP-A1 was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; CBI was negatively correlated with CV_3mm, CV_5mm, and CV_10mm, while SSI was positively correlated with CV_3mm and negatively correlated with CV_10mm (all P<0.05). At 3 months after SMILE, ARTh was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; CBI was negatively correlated with CV_3mm, and positively correlated with CV_10mm (all P<0.05). Conclusion: This study demonstrated that at 3 months after SMILE, CV_3mm, CV_5mm, CV_7mm, CV_10mm, intraocular pressure, and CCT in the central and peripheral areas decreased significantly compared with to those before the operation, and the more peripheral the area, the more the CV decreased. Three months after SMILE, the new corneal biomechanical parameters of the new generation Corvis^® ST changed significantly compared to those before the operation, and there was a certain correlation between CV in different regions and corneal biomechanical parameters. It is expected that CV in different regions after SMILE can characterize some changes in corneal biomechanical properties after SMILE, and CV may become a parameter factor for characterizing and predicting the development of corneal dilatation.

目的：观察盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术中的临床应用效果，评价盐酸艾司氯胺酮联合丙泊酚在小儿眼睑肿物刮除术麻醉中的有效性和安全性。方法：选择2020年11月至2021年7月在佛山市第二人民医院择期行眼睑肿物刮除术的70例患儿，随机分为A组和B组，每组35例。A组采用七氟烷联合丙泊酚复合麻醉，B组采用盐酸艾司氯胺酮联合丙泊酚复合麻醉。记录两组患儿诱导时间、手术时间、苏醒时间、复苏总时间；监测麻醉前、麻醉后5 min、手术开始前、手术结束后患儿血流动力学及呼吸频率变化；记录两组患儿苏醒后即刻、返回病房即刻的东安大略儿童医院疼痛评分量表(Children’s Hospital of Eastern Ontario Pain Scale，CHEOPS)疼痛评分、躁动评分、恶心呕吐评分。结果：两组患儿麻醉诱导时间比较差异无统计学意义(P>0.05)；两组患儿麻醉过程中血流动力学水平、呼吸频率差异无统计学意义(P>0.05)；B组患儿苏醒时间、复苏总时间均明显低于A组(P<0.05)；B组患儿苏醒后即刻及返回病房即刻CHEOPS疼痛评分、躁动评分、恶心呕吐评分均明显低于A组(P<0.05)。另外，B组患儿术后出现恶心呕吐概率低于A组(P<0.05)。结论：盐酸艾司氯胺酮联合丙泊酚应用于小儿眼睑肿物刮除术麻醉，能提供良好麻醉镇痛效果，降低躁动反应和恶心呕吐的发生

Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.