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3讨论
众所周知，验光是眼科检查的主要项目之一，其结果受调节的影响较大，尤其是是青少年儿童。临床上常用阿托品或托吡卡胺滴眼液麻痹睫状肌后进行验光。前者睫状肌麻痹作用虽然很强，但起效慢、作用持续时间太长，给被检者带来很多麻烦和负担；后者虽然起效快、恢复时间短，但睫状肌麻痹作用欠佳。盐酸环喷托酯为人工合成的抗胆碱药，通过阻断瞳孔括约肌和睫状肌对胆碱能激动剂的反应，从而使瞳孔散大和睫状肌麻痹，在国外已有50+a的临床应用历史，是眼科检查时的常规用药［6-9］。
对于盐酸环喷托酯滴眼液的主要作用—睫状肌麻痹，本研究结果显示，给药后1/3h睫状肌麻痹作用已明显，残余调节量为1.40±0.97D，已显著减少；给药后3/4h睫状肌麻痹作用接近最大，残余调节量为1.04±0.62D；该作用可维持到给药后5/4h，此作用才开始减弱；给药后48h此作用已完全消失。给药后1/3，3/4，5/4，24h残余调节量均比对照药托吡卡胺小，有显著性差异（P<0.01）。表明盐酸环喷托酯滴眼液的睫状肌麻痹作用起效快，睫状肌麻痹效果比托吡卡胺强，这与国外的多项研究结果相一致［4,5,10-12］。
对于盐酸环喷托酯滴眼液的另一作用—瞳孔散大，本研究结果显示，给药后1/3h瞳孔已明显散大；给药后5/4h瞳孔散大最明显；给药后24h散瞳作用仍然存在，给药后48h散瞳作用完全消失。与对照药托吡卡胺相比较，在给药后1/3h瞳孔散大没有托吡卡胺明显，给药后3/4和5/4h两者无显著性差异，给药后24h对照药的散瞳作用已完全消失。表明盐酸环喷托酯滴眼液散瞳效应较托吡卡胺慢，但持续时间较托吡卡胺长。本研究结果还显示，滴用盐酸环喷托酯滴眼液后3/4h，睫状肌麻痹作用接近最大，而滴药后5/4h，此作用开始减弱。提示应用本药进行麻痹睫状肌功能的眼科检查时，最好在给药后3/4～5/4h之间进行。
总之，盐酸环喷托酯滴眼液的睫状肌麻痹作用起效快，睫状肌麻痹效果比较强，睫状肌麻痹持续时间足够长，散瞳作用与睫状肌麻痹作用持续时间不超过48h，特别适合需麻痹睫状肌功能的眼科检查，值得临床推广应用。也正是此特点，在国外常规用于需要麻痹睫状肌的屈光检查。
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