臺灣博碩士論文加值系統

淚膜是提供角膜潤滑、營養以及保護的重要結構，當淚膜不穩定即可能造成角膜受損，研究發現(Komnenou et al., 2013; Palma et al., 2020; Ioannides et al., 2022)在全身麻醉的過程中，淚液分泌會顯著的下降，並在術後發生角膜磨損、潰瘍。目前推測鎮靜的過程中也會降低淚液分泌，且有研究(Dodam et al., 1998; Sanchez et al., 2006; Ghaffari et al., 2010)針對不同藥物、劑量對淚液量的影響。本研究的目的是評估使用臨床上常用之鎮靜劑量下，健康犬隻以靜脈單獨給予Tiletamine-Zolazepam(TZ)，或合併使用Dexmedetomidine(D)，鎮靜過程中，以Schirmer tear test 1 (STT1)測量淚液量。受試動物為來院進行健康檢查或影像學檢查，不限制性別、年齡，共有22隻犬隻納入此實驗，其中有6隻犬隻因檢查需要而進行二次鎮靜，故22隻犬，鎮靜次數共28次。實驗分為兩組，第一組為TZ組，共14隻犬隻，以靜脈給予5 mg/kg TZ，第二組為TZD組，共14隻犬隻，以靜脈給予2 mg/kg TZ，加上2 µg/kg D，實驗記錄注射藥物前、注射藥物後1分鐘、15分鐘、30分鐘、45分鐘、60分鐘的STT數值。結果顯示，TZ組別中，相較注射前的STT數值，右眼在注射後30、60分鐘顯著上升、左眼在注射後45、60分鐘顯著上升；而在TZD組別中，右眼在注射後1分鐘顯著下降、注射後60分鐘顯著上升、左眼在注射後1、15分鐘顯著下降。在實驗中的劑量下，TZD會造成STT數值顯著下降，雖然TZ組別並不會造成STT顯著下降，但眨眼頻率受到影響，且並未得知淚液成分是否受到影響，因此仍建議在給予相同鎮靜藥物、劑量時，應補充人工淚液，避免發生併發症。

Both general anesthesia (GA) and sedation can cause decrease on tear production. Corneal abrasion/erosion or ulceration is the most commonly seen complications after GA. Although several studies had been published, it is not fully known of the impact of all sedative protocols on tear production. The aim of this study is to report the effects of intravascular (IV) Tiletamine-Zolazepam(5 mg/kg, TZ) or Tiletamine-Zolazepam(2 mg/kg) + Dexmedetomidine(2 µg/kg) (TZD) on Schirmer tear test 1 results during sedation in healthy dogs. 22 healthy dogs were recruited into the present study, 6 dogs received both types of sedation protocol. All dogs were allocated randomly into two groups (TZ/TZD), 14 dogs for each group. Schirmer tear test 1 were tested before sedation (TB), 1(T1), 15(T15), 30(T30), 45(T45) and 60(T60) minutes after injection. For group TZ, measurements were significantly higher at T30 and T60 on OD compared to TB; measurements were significantly higher at T45 and T60 on OS compared to TB. As for group TZD, measurements were significantly lower at T1 and T15 on OS; measurements were significantly lower at T1 and significantly higher at T60 on OD. Results in present study were similar to previous studies. TZD do decrease the tear production. Although TZ does not decrease the tear production in the present study, blink rate is negatively affected. Meanwhile, we do not know whether tear quality is affected or not. As a result, it is suggested to administer eye lubricant after administration of these two types of sedation protocols.

摘要 i
Abstract ii
目次 iii
表目次 v
圖目次 vi
第一章 序言 1
第二章 文獻探討 2
第一節 淚膜與角膜的結構與生理 2
一、淚膜的結構與生理 2
二、角膜的結構與生理 2
第二節 淚液的神經調控 5
一、三叉神經的解剖構造 5
二、角膜的神經支配 5
三、淚液刺激反射弧 6
第三節 影響淚液的因素 7
一、年齡、性別、體重、溫溼度以及日夜差異 7
第四節 淚液動力學 7
一、 眨眼 7
二、 淚液更新率 8
第五節 藥物概述 8
一、 alpha 2-腎上腺素受體致效劑 8
二、 解離性麻醉劑 10
三、 苯二氮平類衍生物 10
第六節 麻醉及鎮靜對淚液的影響 11
一、 麻醉 11
二、 鎮靜 11
三、 對眼睛造成的併發症及預防的方法 11
第三章 材料與方法 13
第一節 實驗動物 13
一、樣本來源. 13
二、理學檢查 13
三、血清生化學檢查 13
四、眨眼頻率 13
五、眼科學檢查 14
第二節 實驗方法 16
一、實驗分組及實驗設計 16
第三節 統計分析 17
一、統計軟體 17
二、統計方法 17
第四章 結果 18
第一節 基本資料統計 18
第二節 各組不同時間點淚液變化 20
第三節 各組別 STT 數值散布圖 22
第四節 眨眼頻率及 STT 數值的相關性 25
第五節 各組眨眼頻率的比較 25
第六節 受試個體各時間點 STT 數值 26
第五章 討論 28
第六章 結論 34
第七章 參考文獻 35

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