2024年11月 第39卷 第11期

主管:中华人民共和国教育部
主办:中山大学
承办:中山大学中山眼科中心
主编:林浩添
眼科麻醉专题

全身麻醉在青光眼日间手术中的应用分析

The application of general anesthesia in the ambulatory glaucoma surgery

:541-546
 
目的:分析全身麻醉在青光眼日间手术中的应用特点。方法:回顾性收集2023年1月—6月于中山大学中山眼科中心在全身麻醉下接受青光眼日间手术患者71例(全麻组),并选择同时期在局部麻醉下接受青光眼手术患者154例(局麻组),同时以年龄为配对因素行倾向评分匹配分析。主要观察指标为患者术后离院时间,并对患者的手术时间、手术前后眼压、视力、中央前房深度、周边前房深度、甘露醇使用情况以及术后较术前眼压降低差值进行分析。结果:与局麻组比较,全麻组患者术后离院时间未有延长(P>0.05);全麻组患者术前眼压较高(P<0.001)、中央前房深度浅(P=0.018)、周边前房深度浅(P<0.001);且全麻组患者在术后较术前眼压降低差值更大(P=0.002)。组间术后中央前房深度、术后使用甘露醇者比例及术后视力提高者比例比较差异均无统计学意义(P>0.05)。结论:术前眼部条件较差的青光眼患者能在全身麻醉下完成日间手术,且不延长术后离院时间。
Objective: To analyze the application of general anesthesia in the ambulatory glaucoma surgery. Methods: This retrospective study collected 71 patients who underwent ambulatory glaucoma surgery with general anesthesia at Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2023 to June 2023, and 154 patients who underwent similar glaucoma surgery with local anesthesia during the same period. Age differences between the two groups were balanced by propensity score-matched analysis. The main outcome measures were the patients' post-operative discharge time, and the secondary end points included the duration of surgery, the patients' preoperative and postoperative intraocular pressure (IOP), visual acuity status, central anterior chamber depth, peripheral anterior chamber depth, mannitol use, the difference in IOP reduction after surgery compared to preoperative. Results: After propensity score-matched analysis, as compared with group L, general anesthesia did not prolong the patients' post-operative discharge time(P>0.05).Patients in the group G displayed significant higher IOP (P<0.001), shallower central anterior chamber depth (P=0.018), and shallower peripheral anterior depth (P<0.001). The dramatic reductions in IOP after surgery were exhibited in group G as compared with group L(P=0.002). There were no statistically significant differences in postoperative central anterior chamber depth, incidences in postoperative mannitol use, as well as incidences in visual acuity improvement on the first day after surgery. Conclusion: Glaucoma patients with poor preoperative ocular conditions were able to complete the complex glaucoma surgery under general anesthesia without prolonging their post-operative discharge time.

可弯曲喉罩在经鼻内镜眼科日间手术中的应用观察

Application of flexible laryngeal mask in endoscopic ophthalmic day surgery

:547-553
 
目的:探究可弯曲喉罩在经鼻内镜眼科日间手术中应用的安全性。方法:收集2023年1月—2024年1月在全身麻醉(全麻)下行经鼻内镜眼科日间手术成年患者资料,分析可弯曲喉罩使用的成功率,观察患者入室时、插管后、手术开始时、手术结束时的血流动力学变化情况;并记录喉罩置入后、手术开始5 min、手术开始30 min和手术结束时的呼吸参数及患者在麻醉恢复室(post-anesthesia care unit,PACU的停留期间的并发症。结果:共635例患者纳入分析,其中619例患者选用喉罩,607例患者喉罩置入成功,成功率98.1%,喉罩置入失败12例,均为诱导期间置入失败,占1.9%,无术中发生喉罩通气失败改气管插管病例。喉罩通气能满足经鼻内镜手术需求,表现为各时点通气量无显著变化及平稳的心率和平均动脉压。患者均顺利复苏,PACU停留时间为(34.6±11.2) min,喉罩拔除时间为(14.3±4.3) min,无二次气管内插管事件发生。结论:置入成功的可弯曲喉罩可安全应用在经鼻内镜眼科日间全麻手术中。
Objective: To investigate the safety of flexible laryngeal masks in the application of endoscopic ophthalmic ambulatory surgery. Methods: Data of adult patients undergoing endoscopic day ophthalmic surgery under general anesthesia from January 2023 to January 2024 were collected; the changes in hemodynamics at T1 (entry into the operating room), T2 (after intubation), T3 (before surgery), and T6 (after surgery) time points and the respiratory parameters at T2 (after intubation), T4 (5 minutes after surgery), T5 (30 minutes after surgery), and T6 (after surgery) time points were analyzed; meanwhile, the complications during the PACU stay were also analyzed. Results: A total of 635 patients were included in the retrospective analysis, of whom 619 patients were initially used FLMA, FLMA were successfully inserted in 607 patients with a rate of 98.1% while 12 patients suffered insertion failure during the period of anesthesia induction. Importantly, none of patients displayed FLMA ventilation failure and required tracheal intubation during the period of surgery. General anesthesia via FLMA ventilation can provide high quality of surgical field for endoscopic ophthalmic surgery, as evidenced by stable heart rates and mean arterial pressure and no significant change in minute ventilation at each time points. All patients recovered uneventfully with a PACU stay time of 34.6±11.2 min and FLMA removal time of (14.3±4.3) min. None of patients exhibited subsequently endotracheal intubation after FLMA removal. Conclusion: FLMA with successful placement can be safely used for endoscopic ophthalmic ambulatory surgery under general anesthesia.

24 180 例喉罩全身麻醉下接受眼科手术患儿麻醉复苏期的护理体会

Nursing experience of 24,180 children undergoing ophthalmic surgery under general anesthesia with laryngeal mask during anesthesia recovery period

:554-562
 
目的:探讨提高眼科喉罩全身麻醉患儿在麻醉恢复室(post-anesthesia care unit, PACU)复苏质量与效率的整体护理策略。方法:选取2020年1月—2023年12月在中山大学中山眼科中心行眼科全身麻醉并保留喉罩进入PACU复苏的24 180例患儿,总结患儿在PACU复苏的护理措施及复苏质量。结果:所有患儿经复苏期综合护理后均顺利拔除喉罩完成麻醉复苏,未发生苏醒期二次插管或非计划转院治疗。采取个性化的整体护理策略后,喉罩全身麻醉患儿PACU平均复苏时间明显缩短。部分术后常见并发症(术后躁动,低氧血症和呼吸道梗阻)和护理不良事件(留置针脱落和眼包脱落)发生率逐年降低,经治疗和护理后均获得改善。结论:针对眼科全身麻醉的患儿特点,在麻醉复苏期采取个性化的整体护理策略,有利于顺利完成麻醉复苏,降低麻醉并发症和护理不良事件的发生率,提高复苏质量效率,满足眼科日间手术快速康复的需求。
Objective: To explore holistic nursing strategies to improve the quality and efficiency of post-anesthesia care unit (PACU) resuscitation in childrenpatients undergoing ophthalmic laryngeal mask anesthesia. Methods: A total of 24,180 children patients who underwent general anesthesia and retained laryngeal mask airway for PACU resuscitation at Sun Yat-sen Ophthalmic Center of Sun Yat sen University from January 2020 to December 2023 was reviewed and summarized the nursing measures and resuscitation quality of children patients undergoing PACU resuscitation. Results: All patients underwent comprehensive care during the recovery period and successfully removed the laryngeal mask to complete anesthesia recovery. There were no cases of secondary intubation or unplanned transfer for treatment during the recovery period. After adopting personalized holistic nursing strategies, the average recovery time of PACU in children under laryngeal mask anesthesia was significantly shortened.The incidence of common postoperative complications(postoperative agitation, hypoxemia and respiratory obstruction)and adverse nursing events (indwelling needle falls off, eye bandage fall off)had been decreasing year by year. These complications had been improved after treatment and care. Conclusions: Based on the characteristics of children patients undergoing general anesthesia in ophthalmology, adopting personalized holistic nursing strategies during the anesthesia recovery period is beneficial for successfully completing anesthesia recovery, reducing the incidence of anesthesia complications and adverse nursing events, improving the quality and efficiency of recovery, and meeting the needs of rapid recovery in ophthalmic day surgery.

盐酸奥布卡因滴眼液在眼科临床中的应用

Research progress on the application of oxybuprocaine hydrochloride eye drops in ophthalmology

:563-570
 
大部分眼科手术/操作具有创伤小、疼痛刺激轻等特点,因此,选择眼表面麻醉即可满足手术的镇痛的需要,促进了眼科日间手术的广泛开展。其中,盐酸奥布卡因滴眼液是常用的眼科表面麻醉剂,具有麻醉起效迅速、镇痛作用强、持续时间久(约13 min)等特点,已经广泛应用在眼内手术中,在使用过程中,盐酸奥布卡因滴眼液对瞳孔及血管无影响,保证了眼内手术的安全。盐酸奥布卡因滴眼液能提供良好的眼表环境,对角膜厚度及角膜上皮厚度影响轻微,从而满足屈光手术的需要。此外,盐酸奥布卡因滴眼液能提供良好的术后镇痛,减少术后镇痛药物的使用,降低斜视术后患儿的躁动发生率。不含防腐剂的表面麻醉剂不影响麻醉剂的起效时间及镇痛效果,对眼表的影响轻微,从而创造良好的手术操作环境,提高手术效果,降低并发症和手术风险,是眼科手术中较为理想的表面麻醉药物。文章就盐酸奥布卡因滴眼液的作用机制及麻醉效果、药代动力学、临床疗效、安全性等进行综述。
Most ophthalmic surgeries are characterized by small incisions and mild pain, therein, the choice of topical anesthesia can meet the needs of surgeries and accelerate ophthalmic surgeries to be conducted in day surgery model. 0.4% oxybuprocaine hydrochloride eye drops is one of commonly used topical anesthetics for ophthalmic surgery, which has the characteristics of rapid onset and sufficient analgesia with long duration (about 13 minutes). Oxybuprocaine hydrochloride eye drops has been widely and safely used in intraocular surgery without affecting the pupil and blood vessels. Meanwhile, oxybuprocaine hydrochloride eye drops has negligible effects on corneal thickness and corneal epithelial thickness to meet the needs of refractive surgery. In addition, oxybuprocaine hydrochloride eye drops can provide sufficient postoperative analgesia, reduce the use of postoperative analgesics and the incidence of emergence agitation in children after strabismus surgery. The preservative-free topical anesthetic would be one of ideal topical anesthetics as it can provide a good surgical condition and reduce complications and risks of post-operative infections without changing the onset time and analgesia effects. This article provides a review of the mechanism, analgesia, pharmacokinetics, clinical efficacy, and safety profiles of 0.4% oxybuprocaine hydrochloride eye drops.
论著

EZ Prep 清洗液替代二甲苯在眼组织特殊染色中的应用

Application of EZ Prep cleaning solution as a xylene substitute in special staining of ocular tissues

:571-577
 
目的: 探讨EZ Prep清洗液替代二甲苯进行手工脱蜡制作特殊染色片的效果。 方法: 应用EZ Prep清洗液替代二甲苯脱蜡,选取中山大学中山眼科中心临床病理科石蜡标本100例进行回顾性研究,常规切片后切片一式两份,分别采用传统二甲苯和EZ Prep清洗液手工脱蜡后按实验室标准化操作流程进行特殊染色,并比较脱蜡时间和染色效果。 结果: EZ Prep清洗液手工脱蜡处理的切片在革兰染色(Gram's)、六胺银染色(GMS)、过碘酸—雪夫染色(PAS)、马松(Masson)三色染色、刚果红等多种特殊染色中的染色质量和二甲苯脱蜡处理的效果一致,两组间染色片优良率比较差异无统计学意义(Z=0. 32,P>0. 05),且平均脱蜡时间由(33.0±2.7) min缩短至(7.2±1.1) min,加快了染色出片时间。结论:EZ Prep清洗液可以替代二甲苯在眼组织特殊染色中脱蜡,并具有脱蜡时间短、环保的优点,值得推广应用。
Objective: To investigate the effect of EZ Prep cleaning solution as an alternative to xylene for manual deparaffinization in the preparation of special staining slides. Methods: EZ Prep cleaning solution was utilized to replace xylene for deparaffinization in a retrospective study involving 100 paraffin-embedded specimens from the Clinical Pathology Department of Zhongshan Ophthalmic Center, Sun Yat-sen University. Routine sections were prepared and duplicated, with one set deparaffinized using traditional xylene and the other using EZ Prep cleaning solution. Subsequent special staining was performed following standardized laboratory protocols. Deparaffinization time and staining outcomes were compared. Results: Slides treated with EZ Prep cleaning solution for manual deparaffinization demonstrated staining quality comparable to xylene treatment across various special stains, including Gram's, GMS, PAS, Masson's trichrome, and Congo red. The difference in the excellent rate between the two methods is not statistically significant (χ 2 = 0.33, P > 0.05). Moreover, the average deparaffinization time is significantly reduced from 33.0±2.7 minutes to 7.2±1.1 minutes, thereby speeding up the staining process. Conclusion: EZ Prep could replace xylene deparaffinized sections in special staining of ocular tissues with the advantages of shorter deparaffinized time and environmental protection, which is worthy of promotion and application.
综述

眼组学在神经退行性疾病中的研究进展

Research progress of oculomics in neurodegenerative diseases

:578-585
 

神经退行性疾病会损害大脑和神经系统的结构和功能,导致认知和行为能力逐渐下降,因此,早期诊断神经系统疾病可以促进预防、监测和治疗,从而改善患者的预后。眼与脑在结构和胚胎学上的相似之处为评估中枢神经系统的神经和微血管变化提供了潜在可能。眼组学是眼科学、遗传学和生物信息学的交叉学科,目标是开发快速、无创、具有成本效益的生物标志物,用于全身性疾病的筛查、诊断和风险分层。随着诊断和眼科成像技术的进步,用于检测眼的结构、功能和视觉变化的各项技术得到了快速发展。眼部生物标志物成为评估神经退行性疾病进展有前景的工具。文章采用眼部影像学例如光学相干断层扫描(optical coherence tomography, OCT)和OCT 血管成像 (OCT angiography, OCTA)和电生理学例如视觉诱发电位(visual evoked cortical potentials, VEP)、视网膜电图(electroretinogram, ERG)等筛查方法检测眼部异常神经退行性疾病,总结了眼组学在神经退行性疾病的应用,包括阿尔茨海默病、帕金森病、额颞叶痴呆、肌萎缩侧索硬化症和亨廷顿病,旨在为神经退行性疾病的诊断和治疗提供新的思路。尽管并非所有生物标志物都是疾病特异性的,但未来大数据、人工智能和眼组学的融合,有可能进一步深入了解这些神经退行性疾病。

Neurodegenerative diseases can damage the structure and function of the brain and nervous system, leading to a gradual decline in cognitive and behavioral abilities. Therefore, early diagnosis of neurological diseases can promote prevention, monitoring, and treatment, thereby improving the prognosis of patients. The structural and embryological similarities between the eyes and the brain provide potential for evaluating neurological and microvascular changes in the central nervous system. oculomics is an interdisciplinary field that combines ophthalmology, genetics, and bioinformatics, with the goal of developing rapid, non-invasive, and cost-effective biomarkers for screening, diagnosis, and risk stratification of systemic diseases. With the advancement of diagnostic and ophthalmic imaging technologies, various techniques for detecting the structure, function, and visual changes of the eye have been rapidly developed. Eye biomarkers have become promising tools for assessing the progression of neurodegenerative diseases. The article uses screening methods such as eye imaging (such as OCT, OCTA) and electrophysiology (such as VEP, ERG) to detect abnormal neurodegenerative diseases in the eyes. It summarizes the application of oculomics in neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, frontotemporal dementia, amyotrophic lateral sclerosis, and Huntington's disease, aiming to provide new ideas for the diagnosis and treatment of neurodegenerative diseases. Although not all biomarkers are disease-specific, the integration of big data, artificial intelligence, and oculomics in the future may further deepen our understanding of these neurodegenerative diseases.

Faricimab玻璃体腔内注射治疗视网膜静脉阻塞的研究进展

Advances in the treatment of retinal vein occlusion with Faricimab intravitreal injection

:586-592
 
视网膜静脉阻塞(retinal vein occlusion, RVO)是导致视力损害的主要眼底疾病之一,常引发视网膜缺血、出血、液体渗漏和黄斑水肿,从而导致视力下降甚至永久丧失。目前,RVO继发黄斑水肿的主要治疗方法是玻璃体腔内注射抗血管内皮生长因子(vascular endothelial growth factor, VEGF)药物。然而,RVO的病理机制不仅限于VEGF,还涉及血管生成素-2(angiopoietin-2, Ang-2)的作用。在病理状态下,Ang-2通过破坏血管稳定性,诱导新生血管形成,并加剧炎症反应,进一步促进RVO的病程进展。法瑞西单抗(Faricimab)作为一种双特异性抗体药物,能够同时抑制VEGF-A和Ang-2这两条关键的病理通路,显示出在改善患者视力方面的潜在优势。文章对Faricimab在RVO治疗中的作用机制、临床应用、相关治疗药物对比及未来发展前景进行了详细论述,为其在眼科领域的进一步应用提供了理论依据和参考。
Retinal vein occlusion (RVO) is one of the leading retinal diseases causing vision impairment and is often associated with retinal ischemia, hemorrhage, fluid leakage, and macular edema, ultimately resulting in decreased vision or even permanent vision loss. Currently, the primary treatment for RVO-associated macular edema is intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. However, the pathological mechanisms of RVO are not limited to VEGF alone, but also involve angiopoietin-2 (Ang-2). Under pathological conditions, Ang-2 disrupts vascular stability, induces neovascularization, and exacerbates inflammatory responses, thereby accelerating the progression of RVO. Faricimab, as a bispecific antibody, can simultaneously inhibit both VEGF-A and Ang-2 pathways, which are critical in RVO pathogenesis, and has shown potential advantages in improving visual outcomes. The article provides a detailed discussion on the mechanism of action, clinical applications, comparison with related therapeutic agents, and future development prospects of Faricimab in the treatment of RVO, offering a theoretical basis and reference for its further application in ophthalmology.
封面简介

眼科麻醉复苏

Recovery from Ophthalmic Anesthesia

:-
 
眼科日间手术显著提高了医疗效率、节约了医疗资源,眼科麻醉复苏体系的建立则是眼科日间全身麻醉手术的重要安全保障,也是提高眼科手术室效率的重要举措。在眼科手术结束后,全身麻醉患者被即刻转运至麻醉恢复室(post-anesthesia care unit, PACU),此时患者仍处于麻醉状态,密切的监测和呼吸机辅助通气是必不可少的,从而保障患者从麻醉状态逐渐恢复至清醒状态。当患者清醒后,拔除喉罩,各项监测指标达到PACU的转出标准,可进入到Ⅱ期复苏并日间手术离院。然而,在PACU复苏期间,患者易出现喉罩移位、呛咳等引起急性缺氧等呼吸道不良事件的发生,小儿患者则由于术后眼罩遮盖等原因,出现苏醒期躁动的概率高,从而影响到患者顺利转出PACU,间接影响到手术患者的周转。因此,如何预防这些并发症的发生,对提高眼科麻醉复苏质量显得十分重要。
眼科日间手术显著提高了医疗效率、节约了医疗资源,眼科麻醉复苏体系的建立则是眼科日间全身麻醉手术的重要安全保障,也是提高眼科手术室效率的重要举措。在眼科手术结束后,全身麻醉患者被即刻转运至麻醉恢复室(post-anesthesia care unit, PACU),此时患者仍处于麻醉状态,密切的监测和呼吸机辅助通气是必不可少的,从而保障患者从麻醉状态逐渐恢复至清醒状态。当患者清醒后,拔除喉罩,各项监测指标达到PACU的转出标准,可进入到Ⅱ期复苏并日间手术离院。然而,在PACU复苏期间,患者易出现喉罩移位、呛咳等引起急性缺氧等呼吸道不良事件的发生,小儿患者则由于术后眼罩遮盖等原因,出现苏醒期躁动的概率高,从而影响到患者顺利转出PACU,间接影响到手术患者的周转。因此,如何预防这些并发症的发生,对提高眼科麻醉复苏质量显得十分重要。
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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