摘要
目的 探讨眼眶手术前颈部迷走神经阻滞方法对术中眼心反射（OCR）发生情况的影响.方法 对照试验研究.采用随机数字表法,将40例右侧眼眶壁骨折修复术患者分为试验组（Ⅰ组）和对照组（Ⅱ组）,每组20例,全身麻醉前行右侧颈部迷走神经阻滞,Ⅰ组用1%盐酸利多卡因,Ⅱ组用0.9%生理盐水;两组麻醉方法相同.观察阻滞前（T0）、神经阻滞3 min（T1）、5 min（T2）、10 min（T3）、120 min（T4）的平均动脉压（MAP）、心率、Sp02等变化;术中压迫眼球或牵拉眼肌时MAP、心率的变化及阿托品的使用;术后不良反应,阻滞前后血中乙酰胆碱的改变.使用SPSS13.0统计软件对数据进行分析,试验组与对照组组间比较采用成组t检验;组内各时间点之间的比较采用重复测量方差分析方法,两两比较采用q检验;两组的等级资料采用秩和检验;计数资料比较采用卡方检验（x2检验）.结果 Ⅰ组阻滞后3～120 min与阻滞前心率（73±16）比较,明显增快,分别为80±14、98±12、100±13及90±10,差异有统计学意义（F=15.46,P=0.000）;术中OCR的发生例数Ⅰ组（4/20）明显少于Ⅱ组（13/20）,差异有统计学意义（x2=8.28,P=0.004）;OCR的发生程度级别,Ⅰ组发生严重（Ⅱ或Ⅲ级）OCR的例数明显低于Ⅱ组,差异有统计学意义（P=0.029）;阿托品的使用例数Ⅰ组（1/20）也明显少于Ⅱ组（10/20）,差异有统计学意义（x2=10.15,P=0.001）;术后恶心呕吐的发生例数,Ⅰ组低于Ⅱ组,差异有统计学意义（x2=10.15,P=0.001）.Ⅰ组患者血中乙酰胆碱含量,阻滞后低于阻滞前,差异有统计学意义（t=2.935,P=0.003）.结论 眼眶手术前实施颈部迷走神经阻滞可加快患者心率,降低术中OCR发生率及发生程度,减少术中阿托品使用,抑制乙酰胆碱释放,减少恶心呕吐的发生.
Objective To investigate the preventive effect of vagus nerve block in cervical part on Oculocardiac Reflex （OCR）. Methods Case control study. 40 patients undergoing prosthesis of right orbital wall bone fracture were randomly divided into two groups： experiment group （group Ⅰ ） and control group （ group Ⅱ ）. Both of the group adopted vagus nerve block in cervical part before anesthesia. Group Ⅰaccepted 1% lidocaine and group Ⅱ received 0. 9% Sodium Chloride. The same anesthesia method was applied on both groups. We recorded the index change of mean arterial pressure （ MAP）, heart rate （HR）and pulse oxygen saturation （SpO2 ） before （T0） and after vagus nerve block in cervical part 3 min （T1）,5 min （T2）, 10 min （T3） and 120 min （T4 ）; the changes of MAP and HR when we oppressed the eyeball or drag muscular apparatus; the times of using atropine; adverse reactions and the alteration of Acetylcholine （ACh）. Numerical data was carried on statistical analysis processing using the SPSS 13.0. Data among groups were compared by t test and numeration data were compared by chi-square criterion. P-value 〈 0. 05was considered to be statistically significant. Results In group Ⅰ , we found that heart rate significantly increased after block 3 min to 120 min compared with before block （F=15.46, P = 0. 000）; The incidence of OCR was lower, and the incidence of adverse effects in PACU such as nausea and vomiting had statistically significant（ x2 = 8.28, P = 0. 004）; Content of ACh in group Ⅰ changed significantly, it was lower after block than before block （t = 2. 935, P = 0. 003 ）. Conclusion Vagus nerve block in cervical part significantly decreased the incidence of OCR and brought into preventive effect.
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2010年第11期1016-1020,共5页
Chinese Journal of Ophthalmology
关键词
眼外科手术
反射
眼心
迷走神经
神经传导阻滞
乙酰胆碱
Ophthalmologic surgical procedures
Reflex, oculocardiac
Vagus nerve
Nerveblock
Acetylcholine
