Background Patients' experience during phacoemulsification cataract surgery is an important determinant of patient's satisfaction with surgery effectiveness.Local anaesthesia could be associated with different intraoperative visual awareness because of retention of optic nerve function.Relieving the anxiety of patients arose from intraoperative visual awareness is of important clinical significance.Objective This study was to discuss the necessity of preoperative conversation and psychological counseling and to improve the quality of surgery and the satisfaction of patients.Methods One hundred and fifty-three patients who had undergone sequential phacoemulsification and intraocular lens (IOL) implantation in the same operation under local anaesthesia from October,2010 to December,2010 in Tangdu Hospital and Xi'an First People's Hospital,received a standardized questionnaire designed based on similar questionnaires from abroad and surveyed regarding their intraoperative visual experience,including light perception,their detection of color,photopsia,and their detection of the movement of the surgeon,instrument,and changes in light intensity during cataract surgery.In another survey,seventy ophthalmologists in the Xi'an area with ≥ 10 years (33) and ＜ 10 years of experience (37) participated in a questionnaire about their recognition and response to these visual experiences,designed based on the 2010 Chinese Doctors General Questionnaire.Results During the phacoemulsification and IOL implantation,27 patients (17.6％) lost light perception,98 patients (64.1％) had light perception,28 patients (18.3％) detected more than one color,25 patients (16.3％) had photopsia,49 patients (45.1％) sensed the movement of the surgeon,26 patients (17.0％) was able to see surgical instruments,11 patients (7.2％) saw the surgeon's fingers,4 patients (2.6％) saw the surgeons,65 patients (42.5％) detected changes in light intensity and 12 patients (7.8％) saw the IOL loop and others.21.4％ of the 70ophthalmologists believed these patients might have lost light perception;while 78.3％ thought these patients retained light perception.Under local anaesthesia,93.9％ of the more experienced surgeons and 75.6％ of the junior surgeons deemed that good preoperative counseling was helpful for the patients,but only 45.5％ of the more experienced surgeons and 24.3％ of the junior surgeons counseled patients regarding intraoperative visual experience.Conclusions Most patients will experience a variety of visual sensations during phacoemulsification and IOL implantation under local anaesthesia.Many ophthalmologists are aware of these conditions.Most of the ophthalmologists believe that patients suffer from fear from these intraoperative visual experiences and claim that preoperative counseling to patients can relieve that fear,but less of them communicate these possible experiences to patients.This study offers some discussions about preoperative counseling.%背景 白内障患者术中的视觉体验是患者对手术满意度的重要决定因素.局部麻醉因未阻滞视神经功能,患者术中可能出现多种视觉体验.缓解患者由术中视觉体验带来的恐慌感对于改善患者的手术的满意度有着重要的临床意义. 目的 分析局部麻醉下白内障患者在白内障摘出术中的主观视觉体验和眼科医生对患者这种体验的认识,探讨医生进行术前告知和对患者进行心理安抚的必要性. 方法 参考国外通用的患者调查问卷表,对资料完整的153例在局部麻醉下接受超声乳化白内障摘出联合人工晶状体(IOL)植入术的患者进行患者术中主观视觉体验的调查,包括患者在术中的光感、色觉、闪光感,以及对医生动作、光线变化的感觉等;参考2010中国医生调查问卷表,调查70位眼科医生(年资≥10年33位;年资＜10年37位)对局部麻醉和表面麻醉下接受白内障摘出术患者术中视觉体验的认识和态度. 结果 153例接受调查的患者表述术中无光感者27例,占17.6％;有光感者98例,占64.1％;有色觉者28例,占18.3％;有闪光感者25例,占16.3％;感知医生的动作者49例,占45.1％;看见手术器械者26例,占17.0％;看见手术医生的手指者11例,占7.2％;看见手术医生者4例,占2.6％;感知光线的变化者65例,占42.5％;看见IOL襻及其他者12例,占7.8％.接受调查的70位眼科医生中有21.4％认为白内障患者在局部麻醉下无光感,72.9％的医生认为患者术中有光感.分别有93.9％的高年资医生和75.6％的低年资医生(x2=4.393,P＜0.05)认为对患者进行术前告知和心理安抚对手术有帮助,但分别仅有45.5％的高年资医生和24.3％的低年资医生进行了常规的术前告知. 结论 局部麻醉下大部分白内障患者术中有多种不良主观视觉体验,多数眼科医生知道这种视觉体验,并认为术前心理安抚对手术有帮助作用,但仅有少数医生对白内障患者进行常规术前告知.本研究的结果提示眼科医生应重视在术前谈话中告知术中视觉体验的内容,并给予心理安抚.
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