目的：总结全身麻醉斜视矫正日间手术服务模式的创建与安全管理方法。方法：回顾2015年10月至2018年10月期间全身麻醉下行斜视矫正日间手术患者共9 570例。改革护理管理模式，实施医护一体化，在实施过程中对患者进行严密的术前、术后护理管理：术前评估，健康教育前移、加强核查制度、严格监测患者生命体征；术后病情严格交接，家属及患者同步术后指导、离院后回访。结果：全身麻醉斜视矫正日间手术的9 570例患者，均未发生手术并发症，术后不适34例，占0.36%，其中2例患者离院时出现头晕，2例发生尿储留，30例出现恶心、呕吐。护理人力由开展前16人减少到12人，节约25%；患者等候手术时间缩短了8 d，满意度由70%提高到90%，平均住院时间由3.2 d减少为1 d。结论：全身麻醉斜视矫正日间手术模式是一种新的医疗模式，开展全身麻醉日间手术不但可以节省医疗资源，还可提高患者满意度。

Objective: To summarize the establishment and safety management methods of ambulatory strabismus surgery that can provide the basis for carrying out ambulatory surgery nursing under general anesthesia. Methods: We carried out ambulatory surgery management that reformed nursing management model and delivered the integration of medical care in 9 570 patients undergoing strabismus surgery under general anesthesia from October 2015 to October 2018. In implementation process, we carefully managed the patients before and after operation including performing preoperative assessment and health education in advance, strengthening the verification system, strictly monitoring vital signs of the patients, strict shifting state of patients after operation, providing postoperative guidance to patients and their families, and performing follow-up clinic visits after leaving the hospital. Results: No surgical complications occurred in any of our cases. 34 patients had postoperative discomfort, accounting for 0.36%. Among these 34 patients, 2 had dizziness, 2 had urinary retention and 30 had

nausea and vomiting. After treatments, all patients were discharged on schedule. The number of nurses reduced from 16 to 12 that fell by 25%. Wait times for operation reduced by 8 days. Patient satisfaction was improved from 70% to 90%. The mean length of hospital stay was reduced from 3 days to 1 day. Conclusion: The management of ambulatory surgery under general anesthesia is a new medical care service model. Careful planning and strict preoperative and postoperative safety management can ensure the safe implementation of strabismus surgery. Ambulatory surgery under general anesthesia has benefits to save medical resources and improve patient satisfaction.

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：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