摘要
目的观察爱尔卡因滴眼液-苯酚-薄荷油制剂在鼓膜表面麻醉中的效果。方法210例(248耳)行鼓膜部手术患者,随机分为A组(124耳)、B组(68耳)、C组(56耳)。以大小适中的棉片,随机分别浸透爱尔卡因滴眼液-苯酚-薄荷油制剂(A组)、鲍南氏液(B组)和爱尔卡因滴眼液(C组)置于鼓膜表面麻醉,约20 min后取出棉片,进行鼓膜穿孔边缘处理加鼓室冲洗、鼓膜切开加置管、鼓膜周边小肉芽剔除,鼓膜表面病变处理(含烧灼)等耳科门诊手术,并评估三组麻醉剂的麻醉效果、在各类手术中的麻醉效果及术后随访结果。结果A组(124耳)经爱尔卡因滴眼液-苯酚-薄荷油制剂鼓膜表面麻醉效果的良好率为67.7%,总有效率为93.5%,术中未发现眩晕、耳鸣、恶心、呕吐等并发症,术后追踪至少2周亦未发现任何耳道或中耳的并发症;B组(68耳)经鲍南氏液鼓膜表面麻醉效果的良好率为50.0%,总有效率为79.4%,但大部分患者在放置棉片后数分钟内耳道有不同程度的刺痛感;C组(56耳)经爱尔卡因滴眼液鼓膜表面麻醉总有效率的良好率为32.1%,总有效率为60.7%,有10耳(17.9%)须改用其他麻醉方法。A组与B组鼓膜表面麻醉总有效率比较,无显著差异(χ^(2)=3.522,P>0.05)。A组与C组鼓膜表面麻醉总有效率比较,差异显著(χ^(2)=29.945,P<0.01)。A组在穿孔边缘、鼓室冲洗,鼓膜切开、吸引或(和)置管,鼓膜周边小肉芽剔除,鼓膜表面病变处理(含电离子或射频烧灼)手术中麻醉总有效率优于B、C组,差异显著(P<0.05)。术后回访的大多数患耳的气导纯音听阈均值[(0.5 kHz+1 kHz+2 kHz)/3(dBHL)]均有所降低,但鲍南氏液麻醉者中有11耳(16.2%)的骨导听阈提高10~25 dBHL。经爱尔卡因滴眼液-苯酚-薄荷油制剂麻醉的124耳患者中未出现明显的全身性副作用和不良反应。结论将爱尔卡因滴眼液-苯酚-薄荷油制剂用于鼓膜表面麻醉,效果比鲍南氏液稍好,较单纯用爱尔卡因滴眼液优越,同时具有安全、速效、效果确实、制备使用方便、无毒副作用、不易成瘾、价格低廉等优点。
Objective To observe the effect of Alcaine eye drops-phenol-menthol oil preparation in tympanic membrane surface anesthesia.Methods 210 patients(248 ears)who underwent tympanic membrane surgery were randomly divided into group A(124 ears),group B(68 ears)and group C(56 ears).Cotton pieces of moderate size which differently soaked in Alcaine eye drops-phenol-menthol oil preparation(group A),Bonaine's solution(group B)and Alcaine eye drops(group C)were placed on the surface of the tympanic membrane for anesthesia.After about 20 min,the cotton pieces were taken out,and the tympanic membrane perforation edge treatments with tympanic cavity flushing,tympanic incision with additional tube,removal of small granulation around the tympanic membrane,tympanic membrane surface lesions treatments(including cautery)and other otological surgery treatments.The anesthesia effects of three groups of anesthetics,the results of anesthesia in various types of surgeries,and the results of postoperative follow-up were evaluated.Results In group A(124 ears),the excellent rate of tympanic membrane surface anesthesia with Alcaine eye drops-phenol-menthol oil preparation was 67.7%,and the total effective rate was 93.5%;no intraoperative complications such as vertigo,tinnitus,nausea,and vomiting were found,and postoperative follow-up for at least 2 weeks did not reveal any complications in the ear canal or middle ear.In group B(68 ears),the excellent rate of tympanic membrane surface anesthesia with Bonaine's solution was 50.0%and the total effective rate was 79.4%,but most patients had varying degrees of tingling in the ear canal within a few minutes after the cotton pieces were placed.In group C(56 ears),the excellent rate of tympanic membrane surface anesthesia with Alcaine eye drops was 32.1%,and the total effective rate was 60.7%,and 10 ears(17.9%)had to be switched to other methods of anesthesia.There was no significant difference in the effect of tympanic membrane surface anesthesia between group A and group B(χ^(2)=3.522,P>0.05).The effect of tympanic membrane surface anesthesia was significantly different between group A and group C(χ^(2)=29.945,P<0.01).The anesthetic effect of group A was better than that of groups B and group C in the procedures of perforation margin,tympanic cavity irrigation,myringotomy,suction or(and)catheterization,removal of small granulation around the tympanic membrane,tympanic membrane surface lesions treatments(including ion or radiofrequency cautery),and the difference was significant(P<0.05).Most of the patients who underwent postoperative follow-up had a decrease in the mean air conduction pure tone hearing threshold[(0.5 kHz+1 kHz+2 kHz)/3(dBHL)],but the bone conduction hearing threshold was increased by 10-25 dBHL in 11 ears(16.2%)of the patients anesthetized with Bonaine's solution.There were no obvious systemic side effects and adverse reactions in 124 ear anesthetized with Alcaine eye drops-phenol-menthol oil preparation.Conclusion The effect of Alcaine eye drops-phenol-menthol oil preparation for the tympanic membrane surface anesthesia is slightly better than that of Bonaine's solution,superior to that of Alcaine eye drops alone,and has the advantages of safety,quick-acting,reliability,easy-preparation,easy-to-use,no toxic side effects,less addiction,and cheaply-priced.
作者
熊文华
张艺敏
李燕妹
李巧稚
XIONG Wen-hua;ZHANG Yi-min;LI Yan-mei(The Fifth People's Hospital of Nanhai District,Foshan 528000,China)
出处
《中国现代药物应用》
2024年第4期111-114,共4页
Chinese Journal of Modern Drug Application
