目的:探讨表面麻醉,表面麻醉联合球结膜下麻醉及球后麻醉在小梁切除联合超声乳化人工晶状体(IOL)植入术中的可行性并对其效果进行评价。方法:对90例120眼按入院时间先后分成3组,分别用表面麻醉,表面麻醉结合球结膜下麻醉及球后麻醉行小梁切除联合超声乳化人工晶状体植入术,观察麻醉效果及术中、术后的局部及全身并发症。结果:表面麻醉组有3眼因麻醉不足术中追加结膜下麻醉,有11眼因麻醉不足疼痛不能耐受手术。表面麻醉联合球结膜下麻醉全部30眼麻醉效果理想,均顺利完成手术,且无因麻醉量不足或过量及麻醉手法等问题引起的术中或术后的并发症,球后麻醉30眼有1眼出现一过性黑矇,3眼出现球后出血,1眼术后眼睑青紫,经术中及术后对患者的处理及解释病情,均无大碍,也顺利完成手术。结论:三种麻醉方法中以表面麻醉联合球结膜下麻醉在小梁切除联合超声乳化人工晶状体植入术中最安全且有效,为青光眼白内障联合手术的首选麻醉方式。

AIM:To evaluate the reliability and effectiveness of topical anesthesia,topical combined with subconjunctival anesthesia and retrobulbar anesthesia in phacoemulsifi-cation and intraocular lens implantation combined with trabeculectomy.METHODS:Ninety patients(120 eyes) according to admission time were divided into three groups,and underwent the combined surgery of phacoemulsification and intraocular lens implantation combined with trabeculectomy by using topical anesthesia,topical combined with subconjunctival anesthesia and retrobulbar anesthesia respectively.The anesthetic effect and complications intaroperation and postoperation were observed.RESULTS:In topical anesthesia group,3 eyes were given additional subconjuncival anesthesia due to lack of intraoperative anesthesia and 11 cases were not successfully completed due to unsuccessfully satisfactory analgesic effect.All the 30 eyes were successfully completed with satisfactory analgesic effect and without any intraoperative and postoperative potential risk in topical combined with subconjunctival anesthesia group.And in retrobulbar anesthesia group,one eye had transient amaurosis,3 eyes were retrobulbar hemorrhage after operation and one eye’s eyelid was bruising after surgery,with the affective methods of intaroperation and postoperation,these operations all successfully completed.CONCLUSION:Topical combined with subconjunctival anesthesia is the most safe and effective way in these three anesthesia methods,which has an advantage over topical or retrobulbar anesthesia.

R779.66