CAJ | 학술논문

[目的]探讨全身麻醉下机械通气对人体眼内压（IOP）的影响。[方法]选择2012年5～10月本院入院择期行腹部及下肢手术患者100例，术前检查患者均无心肺肝肾系统异常和眼部疾病史，采用连续硬膜外阻滞加气管插管全身麻醉法。以麻醉机行间歇正压通气（IPPV）或不同压力值的呼气末正压通气（PEEP），记录通气前后中心静脉压（CVP）与 IOP 等指标。[结果]IPPV 时，IOP 从通气前的（1．8±0．3）kPa 升至通气30min 后的（1．9±0．3）kPa；PEEP 为5 cmH2 O 及10 cmH2 O 时，IOP 分别从通气前的（2．0±0．3）kPa 升至通气30 min 后的（2．6±0．2）kPa 和通气前的（2．0±0．4）kPa 升至通气30 min 后的（3．0±0．4）kPa，PEEP 较IPPV 对 IOP 造成的影响更大（P ＜0．05），CVP 与 IOP 具有正相关性（r＝0．81，P ＜0．05）。[结论]对青光眼等眼内疾病或眼外伤伴重要脏器损伤手术时若需机械通气，最好选用 IPPV，如必需用 PEEP 时，呼气末正压勿大于10 cmH2 O，以避免严重并发症的发生。
[목적]탐토전신마취하궤계통기대인체안내압（IOP）적영향。[방법]선택2012년5～10월본원입원택기행복부급하지수술환자100례，술전검사환자균무심폐간신계통이상화안부질병사，채용련속경막외조체가기관삽관전신마취법。이마취궤행간헐정압통기（IPPV）혹불동압력치적호기말정압통기（PEEP），기록통기전후중심정맥압（CVP）여 IOP 등지표。[결과]IPPV 시，IOP 종통기전적（1．8±0．3）kPa 승지통기30min 후적（1．9±0．3）kPa；PEEP 위5 cmH2 O 급10 cmH2 O 시，IOP 분별종통기전적（2．0±0．3）kPa 승지통기30 min 후적（2．6±0．2）kPa 화통기전적（2．0±0．4）kPa 승지통기30 min 후적（3．0±0．4）kPa，PEEP 교IPPV 대 IOP 조성적영향경대（P ＜0．05），CVP 여 IOP 구유정상관성（r＝0．81，P ＜0．05）。[결론]대청광안등안내질병혹안외상반중요장기손상수술시약수궤계통기，최호선용 IPPV，여필수용 PEEP 시，호기말정압물대우10 cmH2 O，이피면엄중병발증적발생。
[Objective]To explore the effect of mechanical ventilation on intraocular pressure(IOP)in hu-man body.[Methods]A total of 100 patients undergoing elective spinal operation in our hospital from May 2012 to Oct.2012 were selected.In preoperative examination,all patients had no abnormal heart,lung,liver and kidney function and the history of eye disease.General anesthesia with continuous epidural block and tra-chea intubation was performed.All patients were ventilated with intermittent positive pressure ventilation(IP-PV)and positive end expiratory pressure(PEEP)with different pressures.Parameters such as central venous pressure(CVP)and IOP before and after ventilation were recorded.[Results]When IPPV,the IOP increased from (1.8±0.3)kPa before ventilation to (1.9 ±0.3)kPa after ventilation.If PEEP was 5cmH2 O and 10 cmH2 O,the IOP increased from (2.0±0.3)kPa 30min before ventilation to (2.6±0.2)kPa 30min after venti-lation,and (2.0±0.4)kPa 30min before ventilation to (3.0±0.4)kPa 30min after ventilation.The effect of PEEP on IOP was more significant.CVP was positively correlated with IOP(r=0.81,P <0.05).[Conclu-sion]If mechanical ventilation is required in the surgery of intraocular diseases such as glaucoma or ocular trau-ma with important viscera injury,IPPV is best to be chosen.If PEEP is necessary,the positive pressure at end expiration is not greater than 10cmH2 O in order to avoid serious complications.