中深度镇静下行婴幼儿泪道探通术的临床疗效观察

doi:10.20223/j.cnki.1000-8535.2025.11.011

摘要/Abstract

摘要： 目的探讨口服水合氯醛与鼻内给予右美托咪定中深度镇静下行泪道探通术治疗婴幼儿先天性泪道阻塞的疗效、并发症及安全性。方法随机选择2021年2月—2023年6月在广州医科大学附属妇女儿童医疗中心就诊的先天性泪道阻塞患儿,将其分为观察组和对照组,观察组行中深度镇静后进行泪道探通术,对照组进行表麻下泪道探通术,对比两组的治愈率及并发症发生率。结果观察组共76例（97眼）,总治愈率98.97%,分为3组,6~12月龄组41例（53眼）,12~18月龄组14例（15眼）,18~36月龄组21例（29眼）,对照组共84例（116眼）,总治愈率93.10%,6~12月龄组55例（70眼）,12~18月龄组15例（24眼）,18~36月龄14例（22眼）,观察组泪道探通术治愈率高于对照组,差异有统计学意义（χ2=4.49,P<0.05）。观察组一次探通的成功率为92.78%,高于对照组61.21%,差异有统计学意义（χ2=26.86,P<0.05）。观察组二次探通的成功率为85.71%,高于对照组44.44%,差异有统计学意义（χ2=4.13,P<0.05）。发生的并发症主要是出血、皮下水肿、感染、假道形成,观察组并发症的发生率4.12%,低于对照组15.52%,差异有统计学意义（χ2=7.40,P<0.05）。观察组中2例患儿口服水合氯醛出现恶心呕吐,改为右美托咪定滴鼻。3例患儿右美托咪定滴鼻后出现口唇苍白,持续10~15 min即可缓解。其余均未有不良反应。结论中深度镇静下给予婴幼儿泪道阻塞患儿行泪道探通术相比传统表麻下泪道探通术疗效更好,并发症较少,对孩子的心理创伤小,安全且经济实惠。

关键词: 先天性泪道阻塞, 泪道探通术, 水合氯醛, 右美托咪定, 镇静

Abstract: Objective To explore the efficacy,complications and safety of moderate and deep sedation under oral administration of chloral hydrate and intranasal administration of dexmedetomidine for the treatment of congenital nasolacrimal duct obstruction（CNLDO） in infants and young children．Methods Children with CNLDO who visited our hospital from February 2021 to June 2023 were randomly selected and divided into the observation group and the control group．The observation group was performed with lacrimal duct probing after moderate and deep sedation,while the control group was performed with lacrimal duct probing under surface anesthesia．The cure rate and incidence of complications were compared between the two groups．Adverse reactions after using sedatives were observed．Results The observation group consisted of 76 cases（97 eyes）,with a total cure rate of 98.97%．They were divided into three groups：41 cases（53 eyes）in the aged 6-12 months group,14 cases（15 eyes）in the aged 12-18 months group,and 21 cases（29 eyes）in the aged 18-36 months group．The control group consisted of 84 cases（116 eyes）,with a total cure rate of 93.10%．There were 55 cases（70 eyes）in the aged 6-12 months group,15 cases（24 eyes）in the aged 12-18 months group,and 14 cases（22 eyes）in the aged 18-36 months group．The cure rate of lacrimal duct probing in the observation group was significantly higher than that in the control group（χ2=4.49,P<0.05）．The success rate of the first probing in the observation group was 92.78%,significantly higher than that in the control group of 61.21%（χ2=26.86,P<0.05）．The success rate of the second probing in the observation group was 85.71%,significantly higher than that in the control group of 44.44%（χ2=4.13,P<0.05）．The incidence of complications mainly were bleeding,subcutaneous edema,infection,and false passage formation．The incidence of complications in the observation group was 4.12%,lower than that in the control group 15.52%,and the difference was statistically significant（χ2=7.40,P<0.05）．Two cases in the observation group experienced nausea and vomiting after taking chloral hydrate orally,and were replaced with dexmedetomidine nasal drops．Three cases of pediatric patients showed pale lips after nasal administration of dexmedetomidine,which lasted for 10-15 minutes and could be relieved．No other adverse reactions were observed．Conclusions Under moderate and deep sedation,lacrimal duct probing treatment for infants and young children with CNLDO showed better therapeutic effects,fewer complications,less psychological trauma to these patients,which is safe and cost-effective,and is suitable for promotion compared to under traditional surface anesthesia．

Key words: congenital nasolacrimal duct obstruction, lacrimal duct probing, chloral hydrate, dexmedetomidine, sedation

谢莉, 陈丽丽, 毛娅妮. 中深度镇静下行婴幼儿泪道探通术的临床疗效观察[J]. 广州医药, 2025, 56(11): 1549-1554.

XIE Li, CHEN Lili, MAO Yani. Clinical observation of therapeutic effect of lacrimal duct probing in infants and young children under moderate and deep sedation[J]. Guangzhou Medical Journal, 2025, 56(11): 1549-1554.

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