不同麻醉方式下斜视手术中眼心反射相关因素的研究

王媛1，刘春民1，宋桂婷2，韩冰1，赵东升2，钟华红1

1.深圳市眼科医院(暨南大学附属深圳市眼科医院,深圳市眼科重点实验室)小儿眼科，广东深圳518040；

2.深圳市眼科医院(暨南大学附属深圳市眼科医院,深圳市眼科重点实验室)麻醉科，广东深圳518040

[摘要]目的通过观察不同麻醉方式下斜视手术中心率的变化，了解不同麻醉方式下眼心反射（OCR）发生的几率及OCR的影响因素。方法收集2014年6—10月需施行斜视手术的患者，按麻醉需要分静脉强化麻醉、静脉全麻2组，每组34人。观察患者术前和术中牵拉每条眼外肌时的心率的变化及OCR发生率。结果①OCR在静脉全麻组、静脉强化麻醉组发生率分别为42.3%、61.3%，两者比较差异有统计学意义（P＜0.05）。②OCR在内直肌、外直肌、下斜肌手术时的发生率不同；内、外直肌之间的差异无统计学意义（P＞0.05），强化麻醉下内、外直肌与下斜肌之间的差异有统计学意义（P＜0.05）。③OCR在男性与女性的发生率不同；但差异无统计学意义（P＞0.05）。④不同年龄组的OCR发生率不同，但是在相同的麻醉方式下，其差异无统计学意义（P＞0.05）。结论①全麻、强化麻醉下OCR发生率有差别。②内、外直肌与下斜肌手术时OCR发生率不同。③男女性别差异、年龄对OCR发生率影响不大。

[关键词]斜视；眼心反射；眼外肌；麻醉

[中图分类号]R4

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0019-04

[作者简介]王媛（1979.9-），女，山东乳山人，硕士研究生，主治医师，主要从事小儿眼科斜弱视专科工作。

Abstract[]Objective To observe the changes of heart rate in strabismus surgery under different anesthesia so as to investigate the incidence and the related factors of oculocardiac reflex (OCR) in strabismus surgery under different anesthesia.Methods Sixtyeight cases undergoing strabismus surgery from June 2014 to October 2014 were divided into two groups as needed, the intravenous potentiated anesthesia group, intravenous general anesthesia group with 34 cases in each.The changes of heart rate during the traction of each extraocular muscle (EOM) before and during the surgery and the incidence of OCR in the patients were observed.Results①The incidence of OCR was lower in intravenous general anesthesia group than that in intravenous potentiated anesthesia group (42.3% vs 61.3%) (P<0.05).②The incidence of OCR was different during the medial rectus, lateral rectus, and inferior oblique muscle surgery.The difference in the incidence of OCR between medial rectus and lateral rectus surgery was not statistically significant (P>0.05).The incidence of OCR between medial rectus, lateral rectus, and inferior oblique muscle surgery under intravenous potentiated anesthesia was statistically significant (P<0.05).③The incidence of OCR was higher in men than in women, but the difference was not statistically significant (P>0.05).④The incidence of OCR was different between different age group, but the difference was not statistically significant in the same anesthesia(P>0.05).Conclusion①The effect of the two anesthetic methods on the incidence of OCR was different.②The incidence of OCR was different during the medial rectus, lateral rectus, and inferior oblique muscle surgery.③The different gender or age created the similar small influence on the incidence of OCR.

Study on the Related Factors of Oculocardiac Reflex in Strabismus Surgery Under Different Anesthesia

WANG Yuan1, LIU Chun-min1, SONG Gui-ting2, HAN Bing1, ZHAO Dong-sheng2, ZHONG Hua-hong1

1.Department of Pediatric Ophthalmology, Shenzhen Eye Hospital (Shenzhen Eye hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology), Shenzhen, Guangdong Province, 518040 China;2.Department of Anesthesiology, Shenzhen Eye Hospital (Shenzhen Eye hospital Affiliated to Jinan University, Shenzhen Key Laboratory of Ophthalmology), Shenzhen, Guangdong Province, 518040 China

[Key words]Strabismus; Oculocardiac reflex(OCR); Extraocular muscle; Anesthesia

眼心反射（ocularcardiac reflex, OCR）是眼部手术中，压迫或者牵拉眼部组织或者眼眶组织时所引起的心率减慢、心律异常，或伴有恶心、呕吐、胸闷等不适的异常症状。自……