國(guó)產(chǎn)散瞳藥在白內(nèi)障超聲乳化術(shù)前準(zhǔn)備及術(shù)中散瞳效果的臨床觀察

1、國(guó)產(chǎn)散瞳藥在白內(nèi)障超聲乳化術(shù)前準(zhǔn)備及術(shù)中散瞳效果的臨床觀察         11-03-03 10:13:00     作者：蒲衛(wèi)星,湯欣,宋慧     編輯：studa20【摘要】  目的：比較國(guó)產(chǎn)散瞳藥卓比安與進(jìn)口散瞳藥美多麗在老年性白內(nèi)障超聲乳化聯(lián)合人工晶狀體植入術(shù)前及術(shù)中的散瞳效果。方法：患者200例術(shù)前1d隨機(jī)分為兩組,每組各100例：試驗(yàn)組為卓比安組和對(duì)照組美多麗組。點(diǎn)眼前測(cè)量?jī)山M雙側(cè)瞳孔大小并記錄，共3次點(diǎn)藥，每

2、隔5min 1次，點(diǎn)藥結(jié)束后15，20，25min觀察并記錄瞳孔直徑大小，及瞳孔開(kāi)始回縮時(shí)間。卓比安組和美多麗組于術(shù)前1h點(diǎn)藥3次，每次間隔5min，白內(nèi)障超聲乳化術(shù)中 ,觀察并記錄術(shù)前，注入黏彈劑后，超聲乳化完成后瞳孔直徑及有效超聲乳化時(shí)間,并進(jìn)行統(tǒng)計(jì)學(xué)比較。結(jié)果：卓比安組與美多麗組術(shù)前1d間隔5min 3次點(diǎn)藥，于點(diǎn)藥結(jié)束后20min左右均能達(dá)到最大瞳孔直徑，且兩組最大瞳孔直徑無(wú)統(tǒng)計(jì)學(xué)差異;卓比安組與美多麗組瞳孔開(kāi)始回縮時(shí)間(h)分別為2.49±0.75h與2.85±0.74h,且兩者有統(tǒng)計(jì)學(xué)差異。超聲乳化過(guò)程中國(guó)產(chǎn)散瞳藥卓比安與美多麗維持散瞳效果相同。結(jié)論：國(guó)產(chǎn)散瞳藥

3、卓比安組與進(jìn)口散瞳藥美多麗組相比術(shù)前與術(shù)中散瞳效果無(wú)統(tǒng)計(jì)學(xué)差異，但術(shù)前瞳孔維持最大直徑時(shí)間(h)卓比安組要比美多麗時(shí)間短，且兩者有統(tǒng)計(jì)學(xué)差異。 【關(guān)鍵詞】  美多麗;卓比安;散瞳;白內(nèi)障;超聲乳化AbstractAIM: To observe the effects of domestic mydriatic before and during phacoemulsification.METHODS: The selected 200 patients were divided equally into the experiment group (zhoubian group) an

4、d the control group(MydrinP groups) randomly. The pupil diameter 15,20,25 minutes after three times dropping mydriatics was recorded respectively and the time of pupil started to recession one day before operation. After dropping mydriatic one hour before operation, the pupil diameter was recorded b

5、efore operation, after sodium hyaluronate injected and at the end of operation. The entire operation time and the effective phacotime was recorded. Then the data obtained from 2 groups were compared.RESULTS: The maxdiameter of pupils in the experiment group and the control group were (7.45±0.72

6、) mm and (7.22±0.97) mm respectively 20 minutes after dropping the mydriatic, there was no difference between the 2 groups .But the recession time in the experiment group and the control group were (2.85±0.74) hours and (2.49±0.75) hours,the difference between two groups was significa

7、nt.The maintenance effect of mydriasis during phacoemulsification also has no difference between two groups regarding to the same lens nucleus hardness.CONCLUSION:The domestic mydriatic zhuobian has the same effect of mydriasis preoperation and during operation, but in zhoubian group the recession t

8、ime was shorter than MydrinP group, and the difference was significant.KEYWORDS: MydrinP; zhuobian ; effects of mydriasis; cataract; phacoemulsificatiomPu WX, Tang X, Song H. Clinical study of the effects of the domestic mydriatic before and during phacoemulsification. Int J Ophthalmol(Guoji Yanke Z

9、azhi) 2010;10(9):16891691白內(nèi)障超聲乳化聯(lián)合人工晶狀體(IOL)植入術(shù)是目前白內(nèi)障患者恢復(fù)視力的最佳手術(shù)方式。它具有切口小，手術(shù)時(shí)間短，術(shù)后散光度數(shù)小、視力恢復(fù)快、對(duì)眼組織損傷小，患者感覺(jué)舒適的優(yōu)點(diǎn)1。手術(shù)的成功除了有賴(lài)于術(shù)者良好的手術(shù)操作技巧外，術(shù)前散瞳是術(shù)前準(zhǔn)備的一項(xiàng)重要環(huán)節(jié)2。術(shù)前散瞳效果和術(shù)中散瞳效果維持直接影響到醫(yī)生的手術(shù)操作、手術(shù)時(shí)間和手術(shù)質(zhì)量。所以散瞳準(zhǔn)備成為手術(shù)成功一個(gè)重要的因素。目前臨床常用的散瞳藥物是日本參天制藥株式會(huì)社生產(chǎn)的復(fù)方托吡卡胺滴眼液美多麗，其規(guī)格為10mL含托吡卡胺50mg，鹽酸去氧腎上腺素50mg，其藥理作用為托吡卡胺具有阿托品樣的抗膽

10、堿作用，藥物吸收后可引起散瞳及調(diào)節(jié)麻痹。鹽酸去氧腎上腺素具有交感胺作用，表現(xiàn)為散瞳及局部血管收縮。臨床應(yīng)用于診斷及治療為目的的散瞳和調(diào)節(jié)麻痹，其散瞳效果已被證實(shí)，已在廣大醫(yī)院臨床應(yīng)用。卓比安是中國(guó)興齊藥業(yè)生產(chǎn)的復(fù)方托吡卡胺滴眼液，其規(guī)格為5mL含托吡卡胺25mg，鹽酸去氧腎上腺素25mg，藥理作用與美多麗相同。為評(píng)價(jià)國(guó)產(chǎn)散瞳藥在白內(nèi)障超聲乳化術(shù)前準(zhǔn)備及術(shù)中散瞳效果。我們采用隨機(jī)對(duì)照方法進(jìn)行對(duì)比，現(xiàn)將結(jié)果報(bào)告如下。1對(duì)象和方法1.1對(duì)象選擇200908/200912在我院進(jìn)行白內(nèi)障超聲乳化聯(lián)合IOL植入術(shù)的老年性白內(nèi)障病例200例200眼，其中男83例，女117例，年齡5382(平均67)歲。排

11、除糖尿病、葡萄膜炎、高度近視眼、青光眼等影響散瞳效果的病例。術(shù)前1d隨機(jī)分為兩組：試驗(yàn)組卓比安組，其中男38眼，女62眼，平均年齡65.89±9.94歲;對(duì)照組美多麗組，其中男45眼，女55眼，平均年齡66.86±9.32歲。卓比安組與美多麗組患者核硬度(按照LOCSIII晶狀體核分級(jí)法)級(jí)分別有44眼、48眼，級(jí)分別有33眼、31眼，級(jí)分別有23眼、21眼。兩組間平均年齡、性別、核硬度均無(wú)統(tǒng)計(jì)學(xué)差異。散瞳劑：(1)參天藥物株式會(huì)社生產(chǎn)的10mL美多麗水性滴眼液，藥物成分為含50mg托吡卡胺以及50mg鹽酸去氧腎上腺素。(2)沈陽(yáng)興齊制藥有限公司生產(chǎn)的5mL卓比安滴眼液，藥

12、物成分為含25mg托吡卡胺以及25mg鹽酸去氧腎上腺素。1.2方法滴眼藥水前護(hù)理人員清潔雙手，把滴眼液從瓶?jī)?nèi)擠出數(shù)滴沖洗瓶口。向患者做好解釋工作以取得其良好配合后開(kāi)始點(diǎn)藥。患者取臥位，頭略向后仰，先用棉簽擦去分泌物，護(hù)理人員用左手拇指和食指將患者上下眼瞼輕輕撐開(kāi)，充分暴露下結(jié)膜囊，囑患者眼向上注視，右手持眼藥瓶呈45°，距眼睛約1.52cm滴入結(jié)膜囊下穹隆內(nèi)，然后輕提上眼瞼，使整個(gè)結(jié)膜囊內(nèi)充盈眼藥水，壓迫淚囊區(qū) 23min，囑患者安靜閉眼35min。滴眼藥水時(shí),護(hù)理人員動(dòng)作要穩(wěn)、輕,不可觸及眼瞼或睫毛,防止污染。滴眼藥水時(shí)應(yīng)避免將眼藥水直接滴在角膜上,因角膜感覺(jué)靈敏,受藥液刺激會(huì)引起

13、反射性閉眼,將藥液排擠出眼外,達(dá)不到散瞳目的3。以上操作均由同一護(hù)理人員進(jìn)行。200例患者術(shù)前1d隨機(jī)分為兩組,每組各100例：試驗(yàn)組為卓比安組和對(duì)照組美多麗組。共3次點(diǎn)藥，每隔5 min 1次，點(diǎn)藥結(jié)束后15，20，25min觀察并記錄瞳孔直徑大小及瞳孔開(kāi)始回縮時(shí)間。由同一醫(yī)務(wù)人員采用 1mm刻度尺有瞳孔大小形狀的Haab氏專(zhuān)用瞳孔測(cè)量計(jì),在普通外界照明環(huán)境下測(cè)量瞳孔大小。根據(jù)術(shù)前散瞳藥物不同，卓比安組和美多麗組于術(shù)前1h點(diǎn)藥3次，每次間隔5min，白內(nèi)障超聲乳化術(shù)中，觀察并記錄術(shù)前、注入黏彈劑后、超聲乳化完成后的瞳孔直徑，并進(jìn)行統(tǒng)計(jì)學(xué)比較。用眼科專(zhuān)用圓規(guī)進(jìn)行測(cè)量瞳孔直徑，并記錄總手術(shù)時(shí)間及有效超聲乳化時(shí)間。白內(nèi)障超聲乳化聯(lián)合人工晶狀體植入術(shù)由同一白內(nèi)障醫(yī)師操作。用愛(ài)爾卡因表面麻醉后用圓規(guī)測(cè)量術(shù)前瞳孔直徑，于1100位透明角膜用3.0mm穿刺刀作切口進(jìn)入前房，注入透明質(zhì)酸鈉(愛(ài)維)后再次測(cè)量瞳孔直徑，用截囊針作直徑約5.56mm左右連續(xù)環(huán)形撕囊，行水分離、水分層后,乳