中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
36期
3-5
,共3页
董媛媛%蒋忠%周路阳%马正良
董媛媛%蔣忠%週路暘%馬正良
동원원%장충%주로양%마정량
眼内压%Arnold-Chiari畸形%俯卧位
眼內壓%Arnold-Chiari畸形%俯臥位
안내압%Arnold-Chiari기형%부와위
Intraocular pressure%Arnold-Chiari malformation%Prone position
目的 观察Arnold-Chiari畸形手术中眼内压的变化.方法 选择20例择期行Arnold-Chiari畸形手术的患者,分别于全身麻醉后5 min(T0)、俯卧位后5 min(T1)、俯卧位后30 min(T2)、俯卧位后60 min(T3)、手术结束前俯卧位(T4)、恢复平卧位5 min(T)、平卧位后30 min(T6)测量眼内压,同时记录各时间点平均动脉压(MAP)、心率(HR)、呼气末二氧化碳分压(PETCO2)的变化.俯卧位时,患者头部均采用颅骨钉固定于头架上.结果 术中各时间点MAP、HR、PETCO2比较差异均无统计学意义(P＞0.05)；患者T1[(20.9±2.5)mm Hg(1mm Hg =0.133 kPa)]、T2[(17.7±1.7)mm Hg]、T3[(23.9±2.4)mm Hg]、T4[(26.3±1.0)mm Hg]眼内压较T0[(9.5±1.5)mm Hg]明显升高(P＜0.05),T3较T2明显升高(P＜0.05),T4较T3明显升高(P＜ 0.05)；T5(18.6±1.8)mm Hg]较T4明显降低(P＜0.05),但相对T0仍明显升高(P＜ 0.05);T6[(10.3±1.7)mm Hg]基本恢复到T0水平；颅骨钉的置入可能有一过性加剧眼内压升高的可能,T1眼内压较T2明显升高(P＜0.05).结论 ArnoldChiari畸形手术中随着体位改变患者眼内压逐渐升高,颅骨钉的置入可使眼内压一过性升高.
目的 觀察Arnold-Chiari畸形手術中眼內壓的變化.方法 選擇20例擇期行Arnold-Chiari畸形手術的患者,分彆于全身痳醉後5 min(T0)、俯臥位後5 min(T1)、俯臥位後30 min(T2)、俯臥位後60 min(T3)、手術結束前俯臥位(T4)、恢複平臥位5 min(T)、平臥位後30 min(T6)測量眼內壓,同時記錄各時間點平均動脈壓(MAP)、心率(HR)、呼氣末二氧化碳分壓(PETCO2)的變化.俯臥位時,患者頭部均採用顱骨釘固定于頭架上.結果 術中各時間點MAP、HR、PETCO2比較差異均無統計學意義(P＞0.05)；患者T1[(20.9±2.5)mm Hg(1mm Hg =0.133 kPa)]、T2[(17.7±1.7)mm Hg]、T3[(23.9±2.4)mm Hg]、T4[(26.3±1.0)mm Hg]眼內壓較T0[(9.5±1.5)mm Hg]明顯升高(P＜0.05),T3較T2明顯升高(P＜0.05),T4較T3明顯升高(P＜ 0.05)；T5(18.6±1.8)mm Hg]較T4明顯降低(P＜0.05),但相對T0仍明顯升高(P＜ 0.05);T6[(10.3±1.7)mm Hg]基本恢複到T0水平；顱骨釘的置入可能有一過性加劇眼內壓升高的可能,T1眼內壓較T2明顯升高(P＜0.05).結論 ArnoldChiari畸形手術中隨著體位改變患者眼內壓逐漸升高,顱骨釘的置入可使眼內壓一過性升高.
목적 관찰Arnold-Chiari기형수술중안내압적변화.방법 선택20례택기행Arnold-Chiari기형수술적환자,분별우전신마취후5 min(T0)、부와위후5 min(T1)、부와위후30 min(T2)、부와위후60 min(T3)、수술결속전부와위(T4)、회복평와위5 min(T)、평와위후30 min(T6)측량안내압,동시기록각시간점평균동맥압(MAP)、심솔(HR)、호기말이양화탄분압(PETCO2)적변화.부와위시,환자두부균채용로골정고정우두가상.결과 술중각시간점MAP、HR、PETCO2비교차이균무통계학의의(P＞0.05)；환자T1[(20.9±2.5)mm Hg(1mm Hg =0.133 kPa)]、T2[(17.7±1.7)mm Hg]、T3[(23.9±2.4)mm Hg]、T4[(26.3±1.0)mm Hg]안내압교T0[(9.5±1.5)mm Hg]명현승고(P＜0.05),T3교T2명현승고(P＜0.05),T4교T3명현승고(P＜ 0.05)；T5(18.6±1.8)mm Hg]교T4명현강저(P＜0.05),단상대T0잉명현승고(P＜ 0.05);T6[(10.3±1.7)mm Hg]기본회복도T0수평；로골정적치입가능유일과성가극안내압승고적가능,T1안내압교T2명현승고(P＜0.05).결론 ArnoldChiari기형수술중수착체위개변환자안내압축점승고,로골정적치입가사안내압일과성승고.
Objective To observe the changes of intraocular pressure(IOP)in surgical treatment of Arnold-Chiari malformation.Methods The IOP of 20 patients who underwent surgical treatment of ArnoldChiari malformation were detected by Tono-Pen tonometer at 5 min utes after general anesthesia(T0),5 minutes after prone position(T1),30 minutes after prone position(T2),60 minutes after prone position(T3),prone position before the end of operation(T4),5 minutes after recovery prostration position(Ts)and 30 minutes after prostration position(T6),mean aortic pressure(MAP),heart rate(HR)and partial pressure of carbon dioxide in end tidal(PETCO2)were recorded at the same time.With the prone position,head was fixed bead-holder with skull pin.Results There was no statistical difference in MAP,HR,PEtCO2 at each time point(P＞ 0.05).The IOP significantly increased at T1[(20.9 ±2.5)mm Hg(1 mm Hg =0.133 kPa)],T2[(17.7 ± 1.7)mm Hg],T3[(23.9 ±2.4)mm Hg],T4[(26.3 ± 1.0)mm Hg]compared with IOP at T0 [(9.5 ± 1.5)mm Hg](P ＜ 0.05),there were significant differences between T2 and T3,T3 and T4(P ＜ 0.05).Recovery prostration position,the IOP decreased gradually,IOP at T5[(18.6 ± 1.8)mm Hg]was significantly lower than that at T4(P ＜ 0.05),but T5 was still higher than T0(P ＜ 0.05).The IOP at T6[(10.3 ± 1.7)mm Hg]was no difference compared with T0.Inserting of skull pin might be increase IOP for a moment,the IOP at T; was significantly higher than that at T2(P ＜ 0.05).Conclusion IOP gradually increases as the patients prone position changes in surgical treatment of Arnold-Chiari malformation,and inserting of skull pin maybe increase IOP for a moment.
