目的 探討環甲膜穿刺丁卡因表面麻醉在ICU患者氣管插管中的可行性、安全性及有效性。方法 納入2009 年11 月至2010 年2 月四川大學華西醫院中心ICU內41 例需要氣管插管的患者, 隨機分為環甲膜穿刺丁卡因表面麻醉組( 丁卡因組) 和對照組。記錄基礎生命體征, 插管時、插管后1 min、5 min 時血流動力學變化, 低氧發生率, 插管時間, 插管成功率, 插管后低血壓發生率, 全麻藥物用量及相關并發癥。結果 丁卡因組氣管插管時和插管后1 min 的心率( HR) 、平均動脈壓 ( MAP) 變化率及心率收縮壓乘積( RPP) 均顯著低于對照組( P lt;0. 05) 。兩組患者插管成功率、低氧發生率無顯著差異( P gt; 0. 05) 。丁卡因組誘導期間全麻藥( 異丙酚) 用量、插管后低血壓發生率、血管活性藥物使用總量均明顯小于對照組( P lt;0. 05) 。丁卡因組所有病例環甲膜穿刺均一次性操作成功, 穿刺時間不超過1 min, 無一例出現局麻藥過敏、中毒反應、皮下或縱隔積氣、食道損傷和氣胸等并發癥, 所有患者氣管插管時無死亡。結論 環甲膜穿刺丁卡因表面麻醉在ICU患者氣管插管中可以減輕氣管插管時患者血流動力學的波動, 減少插管后低血壓發生率, 減少全麻藥、血管活性藥物的用量, 是一種安全、有效、快速、簡便易行和微創的操作方法, 必要時可選擇性使用。
【摘要】 目的 觀察在表面麻醉下不作結膜瓣和傳統的以穹窿為基底結膜切開的小切口白內障摘除聯合5.5 mm直徑人工晶狀體植入術的臨床效果。 方法 收集2007年1月－2010年12月資料較完整的老年性白內障160例，將160例320只眼隨機分成兩組，每組各80例160只眼。在表面麻醉下行小切口白內障手術。A組不做結膜瓣，行長5.5 mm角鞏膜緣的平行切口； B組行以穹窿為基底的傳統的結膜瓣，做長5.5 mm角鞏膜平行切口；兩組均行手法小切口白內障劈核摘除聯合5.5 mm直徑硬質人工晶狀體植入。觀察術后效果及術后并發癥。 結果 術后1個月，患者眼部舒適者:A組154只眼（96.25%），B組141只眼（88.13%），兩組差異有統計學意義（χ2=7.332，Plt;0.05）。術后結膜退縮、下垂、巨大瘢痕：A組7只眼（4.38%），B組29只眼（18.13%），兩組差異有統計學意義（χ2=15.149，Plt;0.01），兩組患者術后1 d、1周及1個月視力比較：1 d，A組120只眼（75.00%），B組128只眼（80.00%）（χ2=1.467，Pgt;0.05）；1周，A組130只眼（81.25%），B組132只眼（82.25%）（χ2=0.084，Pgt;0.05）；1個月，A組138只眼（86.25%），B組139只眼（86.86%）（χ2=0.027，Pgt;0.05）；角膜水腫于術后2周后均消退。 結論 在表面麻醉下不做結膜瓣較做結膜瓣小切口白內障劈核摘除術聯合人工晶狀體植入術省時、對眼表面破壞小，角鞏膜切口較小且較為隱閉，術后恢復快。在基層醫院是一種較好的白內障手術方法。【Abstract】 Objective To observe the clinical effect of non-conjunctival flaps and traditional conjunctival flaps choper extracapsular cataract extraction (ECCE) on patients with senile cataracts. Methods The clinical data of 160 patients with cataracts between January 2007 and December 2010 were collected. The patients were randomly divided into two groups with 80 patients (160 eyes) in each group. The patients in group A underwent the small-incision choper ECCE surgery with non-conjunctival flaps; while the patients in group B underwent the traditional conjunctival flaps. Then the total effective rate, incidence of complications, and satisfaction rate of the two groups were analyzed and compared. Results One month after the surgery, the comfort was found in 154 eyes (96.25%) in group A and in 141 eyes (88.13%) in group B; the difference was significant (χ2=7.332，Plt;0.05). The complications after the surgery including conjunctiva retraction, nutation, and huge scar were found in 7 eyes (4.38%) in group A and in 29 eyes (18.13%) in group B, and the difference was significant (χ2=15.149，Plt;0.01) . The visual acuity of the patients one day, one week and one month after the surgery in the two groups were: one day: 120 eyes (75.00%) in group A and 128 eyes (80.00%) in group B (χ2=1.467，Pgt;0.05); one week: 130 eyes (81.25%) in group A and 132 eyes (82.25%) in group B (χ2=0.084，Pgt;0.05); one month: 138 eyes (86.25%) in group A and 139 eyes (86.86%) in group B (χ2=0.027，Pgt;0.05). The cornea edema was alleviated half month after the surgery. Conclusion Compared with the traditional way, non-conjunctival flaps ECCE may save the surgical time, reduce the damage of the ocular surface, improve the visual acuity and received higher satisfaction rate and less conjunctive complication, which is a good surgical method in local hospital.