Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intra ocular laser coagulation, air-fluid exchange and tamponiding of C3F8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complic ations included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were fo und. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage. (Chin J Ocul Fundus Dis，2004，20：133-136)
Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
目的 探討在局部麻醉下行痔上黏膜環形切除釘合術（procedure for prolapse and hemorrhoids，PPH）治療重度內痔的可行性及臨床應用價值。方法 筆者所在醫院科室從2005年起對32例Ⅲ度及Ⅳ度脫垂性內痔（含1例混合痔）患者均采用苯巴比妥＋氫溴酸東莨菪堿＋利多卡因肛管直腸環形局部浸潤麻醉行PPH術，對其麻醉效果、手術時間、術中及術后疼痛、尿潴留、術后感染、肛門狹窄、住院時間、治療滿意度等進行分析。結果 32例患者均順利完成手術，有1例術中改行低位連續硬膜外麻醉，1例輔加鎮靜劑及鎮痛劑。術后28例對疼痛能耐受，4例需鎮痛藥物；1例患者有肛門墜脹感；所有患者傷口均一期愈合，無尿潴留、術后感染、出血、肛門狹窄等并發癥發生；31例對療效滿意，有1例感肛門墜脹，行溫水坐浴及痔瘡膏納肛治療1周后緩解。住院時間3～6d，平均4d。32例患者均進行有效隨訪，隨訪時間2～4個月，平均3個月，無大便失禁或復發，肛門控便能力均可。結論 局部麻醉下行PPH術治療重度內痔是一種安全可行的手術方法，麻醉操作護理簡單，療效確切，術后并發癥少，術后恢復快，并可減少醫療費用。
目的:觀察丙泊酚靜脈泵注復合腰硬聯合麻醉于剖宮產術中的可行性及安全性。方法:50例ASA I~II級行擇期剖宮產術產婦,于L2-3行腰硬聯合麻醉,確定麻醉平面為T4-6,取出胎兒后靜脈緩推丙泊酚1mg/kg,然后2~4mg·kg-1·h-1靜脈泵入,連續監測平均動脈壓,心率,血氧飽和度,呼吸頻率。結果:腰硬聯合麻醉及靜脈推注負荷劑量丙泊酚后平均動脈壓降低,但無臨床意義。余心率,氧飽和度,呼吸頻率各時點無統計學差異。結論:丙泊酚復合腰硬聯合麻醉用于剖宮產術患者生命體征平穩,鎮靜效果良好。
Objective To explore the feasibility and safety of early feeding after arthroscopic surgery with general anesthesia. Methods One hundred patients undergoing arthroscopic surgery with general anesthesia between January and December 2017 were randomly divided into the routine feeding group and the early feeding group, with 50 cases in each group. In the routine feeding group, patients were feeding after anus gas passage or 6 hours after surgery. Under full assessment, patients in the early feeding group could drink or eat when recovered from anesthesia. The nausea, vomiting, abdominal distension, and thirst incidences and the comfort degree 6 hours after surgery, the time of first stand up on foot, and the length of hospital stay between the two groups were compared. Results There was no statistical difference (P>0.05) in the incidence of disgusting (10.0%vs. 22.0%), vomiting (6.0% vs. 16.0%), abdominal distention (4.0% vs. 12.0%) or length of hospital stay [(6.44±2.28) vs. (6.34±0.94) days]. The difference in the incidence of postoperative thirst (14.0% vs. 40.0%), the comfort degree 6 hours after surgery (2.36±1.21 vs. 4.14±1.53), the time of the first stand up on foot [(17.30±10.32) vs. (20.84±3.92) hours] were statistically significant (P<0.05). Conclusions Early feeding is safe and feasible for the postoperiative arthroscopic surgery after general anesthesia, and can improve the patients’ comfort degree.
目的：本研究旨在比較一種新的腦電參數-腦電非線性指數（ENI）與BIS在丙泊酚靶控輸注時預測鎮靜深度的能力。方法:選擇30例18～60歲，ASA Ⅰ～Ⅱ級，擬行擇期普外科手術患者。每一患者同時監測ENI和BIS。麻醉誘導給予丙泊酚靶控輸注，直至患者意識消失后給予芬太尼和羅庫溴銨行氣管插管。麻醉誘導過程中每30秒進行一次鎮靜評分（采用改良OAA/S評分），并記錄ENI和BIS值以及平均動脈壓（MAP）和心率（HR）。結果:ENI和BIS與鎮靜評分的相關性比MAP和HR高（r=0.90、0.93 vs r=0.77、0.27）。鎮靜過程（改良OAA/S評分）中ENI和BIS有很好的相關性(R2=0.828)。ENI和BIS預測鎮靜深度的能力優于MAP和HR。結論：ENI可提供與BIS相似的反映鎮靜深度的信息，能準確預測不同的鎮靜深度。