低濃度腎上腺素灌注液對(duì)眼部麻醉作用時(shí)間的影響

劉彩虹 吳文力 魏琳

【摘要】 目的 探討白內(nèi)障超聲乳化摘除聯(lián)合人工晶體植入手術(shù)中， 低濃度腎上腺素灌注液對(duì)眼部麻醉作用時(shí)間的影響。方法 22例（22只眼）行白內(nèi)障超聲乳化摘除聯(lián)合人工晶體植入手術(shù)患者， 隨機(jī)分為對(duì)照組和試驗(yàn)組， 每組11例。對(duì)照組患者使用500 ml0.9%復(fù)方氯化鈉注射液和0.5 ml1‰腎上腺素組成的灌注液， 試驗(yàn)組患者使用500 ml 0.9%復(fù)方氯化鈉注射液和0.1 ml1‰腎上腺素組成的灌注液。比較兩組術(shù)眼手術(shù)中麻醉作用維持時(shí)間。結(jié)果 對(duì)照組患者麻醉作用維持時(shí)間調(diào)和均數(shù)為17.238 min， 試驗(yàn)組患者麻醉作用維持時(shí)間調(diào)和均數(shù)為16.179 min， 比較差異無統(tǒng)計(jì)學(xué)意義（t=1.71， P>0.05）。試驗(yàn)組術(shù)畢瞳孔大小均等于手術(shù)開始時(shí)， 均能在整個(gè)手術(shù)過程中維持散孔狀態(tài)。結(jié)論 500 ml 0.9%復(fù)方氯化鈉注射液加入0.1 ml的 1‰腎上腺素組成的灌注液， 既不會(huì)影響術(shù)中麻醉作用時(shí)間， 又能維持瞳孔擴(kuò)大， 還可減小對(duì)眼部角膜內(nèi)皮細(xì)胞的損害， 值得臨床上推廣應(yīng)用。

【關(guān)鍵詞】 腎上腺素;低濃度;眼部;麻醉作用;維持時(shí)間

DOI：10.14163/j.cnki.11-5547/r.2020.10.048

【Abstract】 Objective ? To discuss the effect of low concentration epinephrine infusion on duration of ocular anesthesia during cataract extraction combined with intraocular lens implantation. Methods ? A total of 22 patients （22 involved eyes） undergoing cataract extraction combined with intraocular lens implantation were randomly divided into control group and experimental group， with 11 cases in each group. Patients in the control group received infusion solution consisting of 500 ml of 0.9% sodium chloride solution and 0.5 ml of 1‰ adrenaline. Patients in the experimental group received infusion solution consisting of 500 ml of 0.9% sodium chloride solution and 0.1 ml of 1 ‰ adrenaline. The duration of anesthesia during operation was compared between the two groups. Results ? The median maintenance time of anesthesia effect in the control group was 17.238 min， and the median maintenance time of anesthesia effect in the test group was 16.729 min， and the difference was not statistically significant （t=1.71， P>0.05）. In the experimental group， the pupil size at the end of the operation was equal to that at the beginning of the operation， and it could maintain the state of dilation during the whole operation. Conclusion ? Perfusion solution consisting of 500 ml of 0.9% sodium chloride solution and 0.1 ml of?1‰ adrenaline will not affect the duration of anesthesia， while maintaining pupil dilation， and reducing damage to the corneal endothelial cells. It is worthy of clinical promotion and application.

【Key words】 Epinephrine; Low-concentration; Ocular; Anesthetic effect; Maintenance time

在白內(nèi)障超聲乳化摘除聯(lián)合人工晶體植入手術(shù)中， 麻醉效果好， 麻醉作用維持時(shí)間達(dá)到理想范圍， 是手術(shù)順利進(jìn)行的一個(gè)重要條件。但為了瞳孔維持散大， 便于手術(shù)， 需要在灌注液中加入腎上腺素。目前國內(nèi)較多采用500 ml復(fù)方氯化鈉注射液加入0.5 ml的1‰腎上腺素組成灌注液， 有關(guān)文獻(xiàn)建議用0.1 ml 的1‰代替0.5 ml的1‰腎上腺素[1]。但是， 腎上腺素濃度降低， 會(huì)不會(huì)對(duì)眼部局部麻醉作用維持時(shí)間產(chǎn)生影響， 目前無相關(guān)文獻(xiàn)報(bào)道。為此， 本研究2019年11～12月在22例白內(nèi)障超聲乳化摘除聯(lián)合人工晶體植入手術(shù)中， 將其中11例灌注液中腎上腺素濃度1∶1000000降為1∶5000000進(jìn)行試驗(yàn)， 比較高、低兩種腎上腺素濃度對(duì)術(shù)中麻醉作用維持時(shí)間的影響， 現(xiàn)報(bào)告如下。