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 hadnausea 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：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
