王媛++刘春民++宋桂婷+++韩冰++赵东升++钟华红

[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

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

[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 Sixty-eight 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. Results ①The 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）. ④ The incidence of OCR was different between different age group， but the difference was not statistically significant in the same anesthesia（P>0.05）. Conclusion ①The 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.

[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1908年眼心反射第一次被报道，越来越多的医生在眼科手术中观察到眼心反射的发生，严重的眼心反射，甚至可能出现心搏骤停、呼吸停止等危及生命的情况。斜视手术中需要牵拉一条或多条眼外肌，是眼科手术中发生眼心反射几率较高的手术。随着麻醉技术的进步，患者术中出现严重不适的情况明显减少，但眼心反射的发生率是否减少，不同的麻醉方式下眼心反射的发生是否存在不同，眼心反射反射的发生与哪些因素有关，为了解决这些问题，2014年6—10月该研究者进行了相应的临床研究，现报道如下。