日间玻璃体视网膜手术的可行性

Desai A, Rubinstein A, Reginald A, Parulekar M, Tanner V

Royal Berkshire and Battle NHS trust, Prince Charles Eye Unit, Reading and King Edward VII Hospital, Windsor, UK.

Eye (Lond). 2008 Feb;22(2):169-72. doi: 10.1038/sj.eye.6702515. Epub 2006 Jul 21.

PURPOSE

The indications for vitreoretinal (VR) surgery are increasing as equipment and techniques available improve. In order to decrease demand on limited health resources, day-case surgery would be beneficial in many cases. This study combines a retrospective and prospective arm to examine the feasibility and safety of routine day-case VR surgery.

METHODS

One hundred consecutive patients (50 retrospective and 50 prospective) undergoing VR surgery within the Royal Berkshire NHS trust were included. The retrospective arm aimed to identify the frequency and type of acute ophthalmic or medical intervention during postop overnight stay and the results were used to alter management in the prospective group. The prospective group consisted of patients undergoing a mixture of overnight stay and day-case surgery. All patients in the prospective group had routine subtenon marcaine anaesthesia together with prophylactic pre-operative intravenous acetazolamide. Patients deemed fit postoperatively were offered overnight ward discharge, with obligatory next-day review.

RESULTS

In the retrospective arm, 56% required oral nonsteroidal analgesia on the day of surgery and one patient required narcotic analgesia. Twenty-two per cent patients required intraocular pressure (IOP) control on the day of surgery and one patient required medical intervention in the form of urinary catheterisation. Nineteen patients required intervention on next-day review. In the prospective arm, 86% preferred day case and were suitable, 6% were suitable for day-case but preferred overnight stay and 8% were deemed not fit for discharge. No patient required narcotic analgesics. No patient discharged returned as a casualty overnight. Only one patient required topical beta-blocker for the control of IOP on next-day review.

CONCLUSIONS

These data suggest that many patients who are hospitalised overnight for VR surgery could be safely treated as day cases. Such a shift in the pattern of care for VR surgery could provide a significant improvement in health-care efficiency and minimise patient inconvenience.

目的

随着可用设备和技术的改进，玻璃体视网膜（VR）手术的适应症正在增加。为了减少对有限卫生资源的需求，日间手术在许多情况下将是有益的。本研究结合回顾性和前瞻性研究，以检验常规日间VR手术的可行性和安全性。

方法

纳入在皇家伯克郡国民保健服务信托基金接受VR手术的100例连续患者（50例回顾性研究和50例前瞻性研究）。回顾性研究旨在确定术后过夜期间急性眼科或医疗干预的频率和类型，并将结果用于改变前瞻性研究组的管理。前瞻性研究组由接受过夜和日间手术的患者组成。前瞻性研究组的所有患者均接受常规的球后丁卡因麻醉以及术前预防性静脉注射乙酰唑胺。术后被认为适合的患者可选择夜间出院，并必须在次日进行复查。

结果

在回顾性研究组中，56%的患者在手术当天需要口服非甾体类镇痛药，1例患者需要麻醉性镇痛药。22%的患者在手术当天需要控制眼压，1例患者需要进行导尿形式的医疗干预。19例患者在次日复查时需要干预。在前瞻性研究组中，86%的患者倾向于日间手术且适合，6%的患者适合日间手术但倾向于过夜住院，8%的患者被认为不适合出院。没有患者需要麻醉性镇痛药。没有出院患者在夜间作为急诊返回。只有1例患者在次日复查时需要局部使用β受体阻滞剂来控制眼压。