表面麻醉联合结膜下麻醉在小梁切除手术中的应用.doc免费

【摘要】 　　目的：探讨表面麻醉联合球结膜下麻醉方法行青光眼小梁切除术的可行性并对其效果进行评价。方法：对82例118眼青光眼患者用4g/L倍诺喜表面麻醉结合球结膜下麻醉行青光眼小梁切除术，观察麻醉效果及术中术后并发症。结果：全部患眼均能达到理想的麻醉镇痛效果，顺利完成手术，术中未出现常规麻醉可能出现的局部及全身并发症。结论：表面麻醉联合球结膜下麻醉行青光眼小梁切除术是一种安全、可靠、有效、简便易行的麻醉选择，值得推广应用。 【关键词】 表面麻醉 球结膜下麻醉 青光眼小梁切除术 　　Application of topical anesthesia combined with subconjunctival anesthesia in trabeculectomy 　　Zhao Huo,Jing He,ShengLi Ge 　　Department of Ophthalmology,Affiliated Hospital of Yanan University,Yanan 716000,Shaanxi Province,China 　　AbstractAIM: To investigate the feasibility of topical anesthesia combined with subconjunctival anesthesia in trabeculectomy and evaluate their effectiveness. METHODS: Eightytwo cases (118 eyes) with glaucoma underwent trabeculectomy under topical anesthesia with 4g/L Benoxil combined with subconjunctival anesthesia.The effects of anesthesia and intraoperative and postoperative complications were observed. RESULTS: The narcotic analgesic effect was ideal in all patients,and the surgeries were successful.No local or systemic complications appeared, which might occur during routine anesthesia. CONCLUSION: Trabeculectomy under topical anesthesia combined with subconjunctival anesthesia is a safe, reliable, effective and userfriendly anesthesia option and worth popularizing.  　　KEYWORDS: topical anesthesia;subconjunctival anesthesia; glaucoma trabeculectomy 　　0　引言 　　青光眼是我国当前主要致盲眼病之一,被列为全球第二的不可逆致盲性眼病。小梁切除术是目前治疗青光眼的主要手术之一,而一直以来小梁切除术较多采用球后麻醉和球周麻醉,易出现眼球穿孔和视神经损伤及黑矇等,直接影响手术效果。采用表面麻醉联合球结膜下麻醉可以避免上述并发症的发生。200406/200812对各种类型青光眼82例在表面麻醉联合球结膜下麻醉施行小梁切除术，取得良好效果，现报告如下。 　　1　对象和方法 　　1.1　对象 　　本组共82例118眼，男33例48眼，女49例70眼；年龄31～78（平均60.9）岁。急性闭角型青光眼51例70眼，慢性闭角型青光眼20例31眼，原发性开角型青光眼6例10眼，先天性青光眼2例4眼，继发性青光眼3例3眼。入院时视力：手动～数指者4眼；0.1以下者13眼；0.1～0.5者71眼；0.6～1.0者34眼，入院眼压在14.57～81.65mmHg（1mmHg＝0.133kPa），术前均用降眼压药物或前房穿刺等控制眼压，有6例在28mmHg以上。 　　1.2　方法 　　术前按内眼常规准备。术前15min将4g/L倍诺喜表面麻醉滴眼液滴入结膜囊内，每5min 1次,共3次。在11∶00～1∶00方位球结膜下注射20g/L利多卡因0.2～0.5mL，避开血管，注意不要损伤结膜下血管，以免引起血肿而影响手术操作。作以穹窿部为基底的球结膜瓣，上直肌牵引缝线，巩膜面烧灼止血。做以角膜缘为基底的巩膜瓣4mm×4mm，1/2巩膜