双眼有晶体眼后房型人工晶体植入手术患者两次手术疼痛对比

doi:10.6040/j.issn.1673-3770.0.2021.076

摘要/Abstract

摘要： 目的比较表面麻醉下的有晶体眼后房型人工晶体(ICL)植入手术双眼术前紧张程度、术中疼痛及配合度等,分析双眼疼痛是否存在差异及寻找可能的原因,探寻ICL手术双眼之间的合理间隔期。方法入组分次行双眼ICL手术的120例患者中男18例、女102例,将患者随机分为间隔1 d组及间隔1周组,患者双眼按间隔时间行ICL手术,所有手术均为表面麻醉,经透明角膜切口行ICL植入术。每只眼术前使用视觉模拟(VAS)量表评价患者紧张程度,术中术者评估患者配合程度,记录手术耗时,术后使用VAS量表评估患者术中疼痛程度及整体满意度,患者估计手术耗时。统计学分析比较双眼评分变化和组间差异,并探求疼痛程度与患者一般资料的关系。结果不管是在间隔1 d组还是间隔1周组,患者在第二眼手术时紧张程度较前减轻(1 d组:P<0.01;1周组:P=0.011),疼痛程度明显升高(两组均:P<0.01),手术满意程度变差(两组均P=0.001),估计手术时间延长(两组均P<0.01)。在第二眼术中,患者配合程度变差(两组均:P=0.002),但并不会导致手术耗时的增加(1 d组:P=0.481;1周组:P=0.499)。在第二只眼手术时,有相当一部分患者回忆第一只眼的疼痛会偏低,在1周组差异有统计学意义(1 d组:P=0.082;1周组:P=0.011)。间隔1周组较间隔1 d组第二只眼相对于第一只眼的各指标的变化程度更大,但各指标组间比较差异无统计学意义(P>0.05)。多因素回归分析及多独立样本非参数检验显示,年轻的、未生育的人倾向于有较高的疼痛程度。结论第二只眼ICL手术患者的紧张程度较第一只眼降低,疼痛较前增加,配合度降低,这可能主要与心理因素有关,需要积极进行心理干预。双眼手术间隔1 d时和间隔1周时差别不大,可以根据需要选择ICL手术双眼间隔期。

关键词: 有晶体眼后房型人工晶体植入术, 心理干预, 双眼手术间隔期, 视觉模拟量表, 后房型

Abstract: Objective The objective of this study was to compare the degree of tension, pain, and cooperation between patients who underwent two implantable collamer lens(ICL)implantation surgeries under surface anesthesia, and to analyze whether there was a difference in pain between the two eyes and explore the possible causes of the pain in order to examine the ideal interval between two ICL operations. Methods A total of 120 patients who underwent binocular ICL surgery were enrolled. Among them, 18 were men and 102 were women. Patients were randomly divided into 1-day and 1-week interval groups. ICL implantation surgeries were performed in both eyes according to the research plan. All operations were performed under surface anesthesia, and ICL implantation was performed using a transparent corneal incision. The degree of tension of patients was evaluated by a visual analog scale(VAS)before the operation. The degree of cooperation of patients and the operation duration were evaluated and recorded during the operation, and the degrees of pain and overall satisfaction were evaluated by a VAS scale after the operation. Additionally, patients were asked to estimate the operation duration. The difference between binocular score in the two groups was statistically analyzed and compared, as well as the relationship between the degree of pain and the general information of patients such as gender, age and so on. Results In both the 1-day and 1-week interval groups, the tension of the patients during the second eye surgery was reduced(1-day interval group: P<0.01; 1-week interval group: P=0.011), the degree of pain significantly increased(both groups: P<0.01), the degree of satisfaction decreased(both groups: P=0.001), and the estimated operation duration was longer(both groups: P<0.01). In the second eye surgery, the degree of cooperation of patients declined(both groups: P=0.002), but it did not lead to an increase in the estimation of operation duration(1-day interval group: P=0.481; 1-week interval group: P=0.499). Also during the second eye surgery, a significant number of patients underestimated the pain they had experienced during the first eye surgery. The bias of memory of the 1-week interval group was statistically significant(1-day interval group: P=0.082; 1-week interval group: P=0.011. The changes in all indexes between the first and second eyes in the 1-week interval group were greater than those in the 1-day interval group, but there were no significant differences between groups(P>0.05). Multivariate regression analysis and nonparametric tests with multiple independent samples showed that young people without childbirth history tended to experience higher levels of pain during surgery. Conclusion Compared with the first eye surgery, the degree of tension decreased, the amount of pain increased, and the degree of cooperation decreased in the second eye surgery. This result may be mainly related to psychological factors; therefore, psychological intervention is warranted before the second eye surgery. No significant difference in pain existed between the 1-day and 1-week interval groups. Our results indicate that the time interval between two eye surgeries can be determined according to the patient's request.

Key words: Implatable collamer lens implantation, Psychological intervention, Interval of binocular surgery, Visual analog scale, Posterior chamber lens

中图分类号:

R778.1+1

肖宇,张又尹,邓应平. 双眼有晶体眼后房型人工晶体植入手术患者两次手术疼痛对比[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 88-95.

XIAO Yu, ZHANG Youyin, DENG Yingping. Comparison of pain between two eye operations in patients undergoing implantable collamer lens implantation[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 88-95.

参考文献

[1] 董彦会. 2000—2050年全球近视和高度近视的患病率及趋势研究[J]. 中华预防医学杂志, 2017, 51(4): 294. doi:10.3760/cma.j.issn.0253-9624.2017.04.004.
[2] 许毅从, 杨新军, 余野, 等. 屈光矫正者生命质量量表在中国的应用及评价[J]. 眼科研究, 2007, 25(8): 623-626. doi:10.3760/cma.j.issn.2095-0160.2007.08.017. XU Yicong, YANG Xinjun, YU Ye, et al. Application and evaluation of a quality of life scale for Chinese people with refractive correction[J]. Chin Ophthalmic Res, 2007, 25(8): 623-626. doi:10.3760/cma.j.issn.2095-0160.2007.08.017.
[3] Cao XF, Tong JP, Wang Y, et al. Long-term ultrasound biomicroscopy observation of position changes of a copolymer posterior chamber phakic intraocular lens[J]. J Cataract Refract Surg, 2014, 40(9): 1454-1461. doi:10.1016/j.jcrs.2013.12.022.
[4] 万博, 李东辉, 罗岩, 等. 中心孔型有晶状体眼后房型人工晶体植入术后拱高变化及相关因素分析[J]. 山东大学耳鼻喉眼学报,2020,34(2):36-41. doi:10.6040/j.issn.1673-3770.1.2020.008. WAN Bo, LI Donghui, LUO Yan, et al. Lens vault changes and associated factors after implantation of implantable collamer lenses with central flow[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(2): 36-41. doi:10.6040/j.issn.1673-3770.1.2020.008.
[5] Moshirfar M, Somani AN, Motlagh MN, et al. Comparison of FDA-reported visual and refractive outcomes of the toric ICL lens, SMILE, and topography-guided LASIK for the correction of myopia and myopic astigmatism[J]. J Refract Surg, 2019, 35(11): 699-706. doi:10.3928/1081597X-20190930-01.
[6] Ursea R, Feng MT, Zhou M, et al. Pain perception in sequential cataract surgery: comparison of first and second procedures[J]. J Cataract Refract Surg, 2011, 37(6): 1009-1014. doi:10.1016/j.jcrs.2011.01.020.
[7] Hari-Kovacs A, Lovas P, Facsko A, et al. Is second eye phacoemulsification really more painful?[J]. Wien Klin Wochenschr, 2012, 124(15/16): 516-519. doi:10.1007/s00508-012-0205-2.
[8] Tan CS, Fam HB, Heng WJ, et al. Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial[J]. Br J Ophthalmol, 2011, 95(6): 837-841. doi:10.1136/bjo.2010.188003.
[9] Yu JG, Ye T, Huang Q, et al. Comparison between subjective sensations during first and second phacoemulsification eye surgeries in patients with bilateral cataract[J]. J Ophthalmol, 2016: 6521567. doi:10.1155/2016/6521567.
[10] Price MO, Price FW Jr. Evaluation of the toric implantable collamer lens for simultaneous treatment of myopia and astigmatism[J]. Expert Rev Med Devices, 2015, 12(1): 25-39. doi:10.1586/17434440.2015.984685.
[11] 陈珣, 王晓瑛. 有晶状体眼后房型人工晶状体植入术的发展[J]. 中国眼耳鼻喉科杂志, 2016,16(2): 125-129,134. doi:10.14166/j.issn.1671-2420.2016.02.019. CHEN Xun, WANG Xiaoying. Development of posterior chamber phakic intraocular lens implantation[J]. Chin J Ophthalmol Otorhinolaryngol, 2016,16(2): 125-129,134. doi:10.14166/j.issn.1671-2420.2016.02.019.
[12] Kindler CH, Harms C, Amsler F, et al. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns[J]. Anesth Analg, 2000, 90(3): 706-712. doi:10.1097/00000539-200003000-00036.
[13] Rosas S, Paço M, Lemos C, et al. Comparison between the Visual Analog Scale and the Numerical Rating Scale in the perception of esthetics and pain[J]. Int Orthod, 2017, 15(4): 543-560. doi:10.1016/j.ortho.2017.09.027.
[14] Eke T, Thompson JR. Serious complications of local anaesthesia for cataract surgery: a 1 year national survey in the United Kingdom[J]. Br J Ophthalmol, 2007, 91(4): 470-475. doi:10.1136/bjo.2006.106005.
[15] Guerrier G, Rondet S, Hallal D, et al. Risk factors for intraoperative hypertension in patients undergoing cataract surgery under topical anaesthesia[J]. Anaesth Crit Care Pain Med, 2016, 35(5): 343-346. doi:10.1016/j.accpm.2016.01.005.
[16] Sarkar S, Mondal KK, Roy SS, et al. Comparison of preoperative nepafenac(0.1%)and flurbiprofen(0.03%)eye drops in maintaining mydriasis during small incision cataract surgery in patients with senile cataract: a randomized, double-blind study[J]. Indian J Pharmacol, 2015, 47(5): 491-495. doi:10.4103/0253-7613.165201.
[17] Ogurel T, Ogurel R, Onaran Z, et al. 0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery[J]. Cont Lens Anterior Eye, 2018, 41(5): 448-451. doi:10.1016/j.clae.2018.05.003.
[18] 季青山, 孙思勤, 温跃春. 白内障患者双眼手术中疼痛和配合度的比较[J]. 安徽医药, 2017,21(7): 1209-1212. JI Qingshan, SUN Siqin, WEN Yuechun. Comparison of pain experience and compatibility between consecutive surgeries in patients with bilateral cataract[J]. Anhui Med Pharm J, 2017, 21(7): 1209-1212.
[19] Akkaya S, Özkurt YB, Aksoy S, et al. Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification[J]. Int Ophthalmol, 2017, 37(3): 545-552. doi:10.1007/s10792-016-0295-3.
[20] Bardocci A, Ciucci F, Lofoco G, et al. Pain during second eye cataract surgery under topical anesthesia: an intraindividual study[J]. Albrecht Von Graefes Arch Fur Klinische Und Exp Ophthalmol, 2011, 249(10): 1511-1514. doi:10.1007/s00417-011-1803-9.
[21] Sharma NS, Ooi JL, Figueira EC, et al. Patient perceptions of second eye clear corneal cataract surgery using assisted topical anaesthesia[J]. Eye(Lond), 2008, 22(4): 547-550. doi:10.1038/sj.eye.6702711.
[22] Omulecki W, Laudanska-Olszewska I, Synder A. Factors affecting patient cooperation and level of pain perception during phacoemulsification in topical and intracameral anesthesia[J]. Eur J Ophthalmol, 2009, 19(6): 977-983.
[23] Pastor-Vivas AI, Alejandre-Alba N, García-Vega MI, et al. Quantifying and classifying postsurgical pain in pterygium surgery with conjunctival autografts[J]. Arch Soc Esp Oftalmol, 2011, 86(6): 176-179. doi:10.1016/j.oftal.2010.12.011.
[24] Li X, He Y, Su T, et al. Comparison of clinical outcomes between cystotome-assisted prechop phacoemulsification surgery and conventional phacoemulsification surgery for hard nucleus cataracts: a CONSORT-compliant article[J]. Medicine(Baltimore), 2018, 97(46): e13124. doi:10.1097/MD.0000000000013124.
[25] Strong JA, Xie WR, Coyle DE, et al. Microarray analysis of rat sensory Ganglia after local inflammation implicates novel cytokines in pain[J]. PLoS One, 2012, 7(7): e40779. doi:10.1371/journal.pone.0040779.
[26] Zhu XJ, Wolff D, Zhang KK, et al. Molecular inflammation in the contralateral eye after cataract surgery in the first eye[J]. Invest Ophthalmol Vis Sci, 2015, 56(9): 5566-5573. doi:10.1167/iovs.15-16531.
[27] Jiang L, Zhang KK, He WW, et al. Perceived pain during cataract surgery with topical anesthesia: a comparison between first-eye and second-eye surgery[J]. J Ophthalmol, 2015, 2015: 383456. doi:10.1155/2015/383456.
[28] Piper BJ, DeKeuster RM, Beals ML, et al. Substitution of medical Cannabis for pharmaceutical agents for pain, anxiety, and sleep[J]. J Psychopharmacol, 2017, 31(5): 569-575. doi:10.1177/0269881117699616.
[29] Hudson BF, Ogden J, Whiteley MS. Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery[J]. Eur J Pain, 2015, 19(10): 1447-1455. doi:10.1002/ejp.675.
[30] Adatia FA, Munro M, Jivraj I, et al. Documenting the subjective patient experience of first versus second cataract surgery[J]. J Cataract Refract Surg, 2015, 41(1): 116-121. doi:10.1016/j.jcrs.2014.04.041.
[31] Nijkamp MD, Ruiter RA, Roeling M, et al. Factors related to fear in patients undergoing cataract surgery: a qualitative study focusing on factors associated with fear and reassurance among patients who need to undergo cataract surgery[J]. Patient Educ Couns, 2002, 47(3): 265-272. doi:10.1016/s0738-3991(02)00002-2.
[32] Ang CL, Au Eong KG, Lee SSG, et al. Patients' expectation and experience of visual sensations during phacoemulsification under topical anaesthesia[J]. Eye, 2007, 21(9): 1162-1167. doi:10.1038/sj.eye.6702427.
[33] Nijkamp MD, Kenens CA, Dijker AJ, et al. Determinants of surgery related anxiety in cataract patients[J]. Br J Ophthalmol, 2004, 88(10): 1310-1314. doi:10.1136/bjo.2003.037788.
[34] Foggitt PS. Anxiety in cataract surgery: pilot study[J]. J Cataract Refract Surg, 2001, 27(10): 1651-1655. doi:10.1016/S0886-3350(01)00859-8.
[35] Crawford H, Gijsbers K. Are pain tolerance of female runners and use of pain coping strategies related to the experience of childbirth?[J]. Percept Mot Ski, 2000, 90(3 Pt 1): 1045-1046. doi:10.2466/pms.2000.90.3.1045.
[36] Hapidou EG, DeCatanzaro D. Responsiveness to laboratory pain in women as a function of age and childbirth pain experience[J]. Pain, 1992, 48(2): 177-181. doi:10.1016/0304-3959(92)90056-H.
[37] Mota SH. Pseudomonas aeruginosa-induced bilateral endophthalmitis after bilateral simultaneous cataract surgery: case report[J]. Arq Bras Oftalmol, 2018, 81(4): 339-340. doi:10.5935/0004-2749.20180066.
[38] Hsu CR, Chen JT, Yeh KM, et al. A cluster of nontuberculous mycobacterial endophthalmitis(NTME)cases after cataract surgery: clinical features and treatment outcomes[J]. Eye(Lond), 2018, 32(9): 1504-1511. doi:10.1038/s41433-018-0108-1.
[39] Tan CSH, Chan JC, Ngo WK, et al. Pain during dominant-side or nondominant-side phacoemulsification[J]. J Cataract Refract Surg, 2014, 40(7): 1249-1250. doi:10.1016/j.jcrs.2014.05.011.
[40] Aslankurt M, Aslan L, Ba??塂kan AM, et al. Pain and cooperation in patients having dominant-side or nondominant-side phacoemulsification[J]. J Cataract Refract Surg, 2014, 40(2): 199-202. doi:10.1016/j.jcrs.2013.07.038.
[41] Choi S, Park SG, Bellan L, et al. Crossover clinical trial of pain relief in cataract surgery[J]. Int Ophthalmol, 2018, 38(3): 1027-1033. doi:10.1007/s10792-017-0554-y.
[42] 张瑞, 龚春蓓, 于文春, 等. 眼科手术场景预适应在恐惧症患者中的临床应用[J]. 山东大学耳鼻喉眼学报, 2019,33(5): 125-128. doi:10.6040/j.issn.1673-3770.0.2018.543. ZHANG Rui, GONG Chunbei, YU Wenchun, et al. The clinical application of surgical scene preconditioning for patients with phobia undergoing ocular surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019,33(5): 125-128. doi:10.6040/j.issn.1673-3770.0.2018.543.
[43] 庞晓燕, 王向. 围手术期心理干预对心率变异性及疼痛耐受的影响[J]. 临床麻醉学杂志, 2007,23(9): 715-716. doi:10.3969/j.issn.1004-5805.2007.09.003. PANG Xiaoyan, WANG Xiang. Perioperative influence of psychological interfering on heart rate variability and pain[J]. J Clin Anesthesiol, 2007, 23(9): 715-716. doi:10.3969/j.issn.1004-5805.2007.09.003.

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