【摘要】 目的：探讨表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术的临床效果和安全性。方法：对200701/200801在我院住院治疗的白内障患者105例113眼实施表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术，观察临床效果。结果：术中麻醉效果明显，显效共107眼(94.7%)，有效6眼(5.3%)，总有效率达100%，无病例因疼痛无法承受手术而改行球后或球周麻醉。术后第1d裸眼视力≥0.5者65眼(57.5%)，>0.8者22眼(19.5%);术后1wk裸眼视力≥0.5者85眼(75.2%)，>0.8者17眼(15.0%)，随访1mo未发现明显视力下降。术后1wk视力<0.5者1例(0.9%)，为糖尿病视网膜病变。术后角膜内皮水肿7眼(6.2%)，高眼压4眼(3.5%)，经处理后症状均消失。结论：表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术的临床效果确切，安全性高，值得推荐应用。
【关键词】 表面麻醉;小切口;非超声乳化;白内障摘除;人工晶状体植入术
Clinical research on small incision nonphacoemulsification cataract extraction combined with IOL implantation under topical anesthesia
MingHua Li, ZengQin Zhu,JunHua Zhao, JianChao Liang
Department of Ophthalmology and Otorhinolaryngology, Peoples Hospital of Dianbai County, Dianbai County 525400, Guangdong Province, China
AbstractAIM: To investigate the effect and safty of small incision nonphacoemulsification cataract extraction combined with intraocular lens (IOL) implantation under topical anesthesia. METHODS: The cases with cataract in our hospital from January 2007 to January 2008 received small incision nonphacoemulsification cataract extraction combined with IOL implantation under topical anesthesia, and the clinical effect was observed.RESULTS: The effect of anesthesia was obvious in operation, the excellence rate was 94.7% and good rate was 5.3% and the total effective rate was 100.0%. There was no case who received anesthesia of behind the eyeball and around the eyeball because of pain.There were 65 eyes(57.5%) with naked vision 0.5 or above and 22 eyes(19.5%) with naked vision more than 0.8 in one day after operation. There were 85 eyes(75.2%) with naked vision 0.5 or above and 17 eyes(15.0%) with naked vision more than 0.8 in one day after operation. All of them were followed up for one month and no case was with decressed vision.There was one case (0.9%) with naked vision less than 0.5 because of diabetic retinopathy.There were 7 eyes(6.2%) with corneal endothelium edema, 4 eyes(3.5%) with bulbi hypertonia, and all of symptom disappeared after dealing.CONCLUSION: The effect of small incision nonphacoemulsification cataract extraction combined with IOL implantation under topical anesthesia is obvious and safe, so it is worth being used widely.
KEYWORDS: topical anesthesia; small incision; nonphacoemulsification; cataract extraction; intraocular lens implantation
0引言
白内障是眼科发病率极高的眼病之一，严重影响患者的生活质量。而球后麻醉或/和球周麻醉是传统白内障手术的主要麻醉方式，但因其并发症较多，限制了其在临床的进一步应用。我们对200701/200801在我院住院治疗的白内障患者采用表面麻醉下小切口非超声乳化白内障摘除联合人工晶状体植入术进行治疗并取得良好的效果，现报告如下。
1对象和方法
1.1对象
选取200701/200801在我院住院治疗的白内障手术患者105例113眼，男63例67眼，女42例46眼;年龄18～80(平均63.45±5.60)岁;老年性白内障78眼，青光眼手术白内障19眼，糖尿病并发白内障10眼，伴高度近视白内障4眼，外伤性白内障2眼;术前视力均≤0.3，手术操作时间9.20～23.50(平均16.12±2.45)min。
1.2方法
所有患者按白内障手术常规积极进行术前准备，麻醉采用4g/L盐酸奥布卡因滴眼液，手术前5min开始结膜囊内滴药，2min 1次，2滴/次，共3次。手术常规消毒、铺巾，开睑器开睑;沿角膜缘11∶00～1∶00位剪开球结膜，烧灼止血，于12∶00位上方角膜缘后2～3mm，做反眉式巩膜隧道切口，长约6～7mm，注入黏弹剂，用截囊针作开罐式截囊或连续环形撕囊。分离皮质与核及皮质与囊膜，扩大切口，松动晶状体核，同时反时针转动晶状体核，拨出囊袋至前房。注黏弹剂于核下，用晶状体圈将核娩出，核大者可用切核器将核切成两半再先后娩出，冲洗清除残留皮质，囊袋内植入人工晶状体，切口可不缝合，若水密不良者可间断缝合，包眼，术毕。术后按常规给予妥布霉素地塞米松滴眼液以及托吡卡胺滴眼液点眼。评定麻醉效果、视力恢复情况以及术中术后并发症情况。麻醉效果评定标准[1]：麻醉效果分为显效、有效、无效。显效：手术过程中患者无痛感，能很好地配合手术，眼球固视好;有效：有轻度疼痛或异物感，可忍受并能配合手术顺利完成，或加滴表面麻醉药后能顺利完成手术;无效：疼痛明显，不能配合手术，需改用其他麻醉方法。
2结果
2.1术中麻醉效果
术中麻醉效果明显，显效共107眼(94.7%)，有效6眼(5.3%)，总有效率达100.0%。其中20眼在热凝止血时有灼热感，5眼出现轻度疼痛，1眼有异物感，追加1次表面麻醉后症状消失。无患者因疼痛无法承受手术而改行球后或球周麻醉。
2.2术后视力恢复
术后第1d裸眼视力≥0.5者65眼(57.5%)，>0.8者22眼(19.5%);术后1wk裸眼视力≥0.5者85眼(75.2%)，>0.8者17眼(15.0%)，随访1mo未发现明显视力下降。术后1wk视力<0.5者1例(0.9%)，为糖尿病视网膜病变。
2.3术中术后并发症
术后角膜内皮水肿7眼(6.2%)，予结膜下注射地塞米松加用妥布霉素地塞米松滴眼液点眼后于术后2～5d消失;术后高眼压4眼(3.5%)，予降眼压治疗后于术后1～2d消失。
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