比较双眼先后接受表面麻醉下白内障手术的患者对第1次手术和第2次手术的痛觉感知。

收集2016年10月至2017年10月于湖南中医药大学第一附属医院先后做双眼白内障手术的73例患者的病例资料进行研究。其中，男性32例，女性41例，平均年龄(64±8)岁。全部患者双眼连续行白内障手术，所有手术均经透明角膜切口行超声乳化白内障吸除联合人工晶状体植入术，且手术全程在有麻醉监护的表面麻醉下进行。每一只眼的白内障手术，患者都必须完成2个简短的量表，即用视觉模拟评分对术后疼痛程度进行两次评分(极差为0～10分)。疼痛的程度和双眼疼痛的差别是主要的评价标准。白内障手术评分、程度分级、麻醉剂量和手术持续时间等资料采用K－S法进行正态检验，当数据符合正态分布时，组间比较采用t检验，否则采用威尔科克森(Wilcoxon)符号秩检验，性别和病史等分类资料采用例数和百分比描述，比较采用卡方检验。

全部患者中有41例患者(56%)对第2只眼白内障手术的疼痛程度有更高的视觉模拟评分。第1只眼手术和第2只眼手术的即刻疼痛程度评分中值分别为0(极差为0～6分)和1(极差为0～9分)，其差异有统计学意义(z＝3.48，P<0.05)。但术后第1天，第1只眼手术和第2只眼手术的疼痛程度评分比较，中值均为0(极差为0～9分)，差异无统计学意义(z＝0.78，P>0.05)。所有病例中，有41例对第2只眼手术的疼痛程度评分更高，与另外32例相比，两组疼痛回忆的差异有统计学意义(χ²＝31.01，P<0.05)。

虽然在有麻醉监护的表面麻醉下行白内障手术，患者的疼痛已经很轻，但是对比第1只眼的手术，第2只眼手术的痛觉感知还是明显增加。这可能与术前的焦虑程度紧密相关，也可能与术中静脉镇静药物的遗忘作用有关。本研究的数据有助于解释一系列常见的术后临床观察结果，并应用于白内障围手术期管理研究。

To evaluate and compare the pain perception of cataract patients who underwent cataract surgery under topical anesthesia in both eyes during the first and second operations.

From October 2016 to October 2017, 73 cases who underwent binocular cataract surgery in the First Affiliated Hospital of Hunan University of Chinese Medicine were studied. Among them, there were 32 males and 41 females, with an average age of (64±8) years. All patients underwent continuous cataract surgery in both eyes. All operations were performed through transparent corneal incision with phacoemulsification and intraocular lens implantation, and the operation was performed under topical anesthesia with anesthesia monitoring. For cataract surgery in each eye, patients must complete two short scales, i. e. visual analogue score is used to score the degree of pain twice (range is 0-10 points). The degree of pain and the difference between binocular pain were the main criteria for evaluation. The data of cataract surgery score, degree grading, anesthesia dosage and operation duration were tested by K-S method. When the data were in normal distribution, t-test was used for comparisons between groups. Otherwise, Wilcoxon sign rank test was used for comparisons, and cases andpercentages were used for descriptions of sex and history of cataract. Chi-square test was used for comparisons.

Forty-one cases (56%) had higher visual analogue score for the pain degree of cataract surgery in the second eye. The median immediate pain scores of the first eye and the second eye were 0 (range 0-6) and 1 (range 0-9), respectively. The difference was significant (z=3.48, P<0.05). But on the first day after operation, the pain scores of the first eye operation and the second eye operation were all 0 (range 0-9), and there was no significant difference (z=0.78, P>0.05). Among all the cases, 41 cases scored higher on the pain degree of the second eye operation. Compared with the other 32 cases, the difference of pain recall between the two groups was statistically significant (χ²=31.01, P<0.05).

Although the pain of cataract surgery under topical anesthesia with anesthesia monitoring is very light, the pain perception of the second eye surgery is significantly increased compared with that of the first eye surgery. This may be closely related to preoperative anxiety, or may be related to intraoperative amnesia of intravenous sedatives. The data in this study can help to explain a series of common clinical observations after cataract surgery, and can be applied to the study of perioperative management of cataract.