CAJ | 학술논문

目的：实时监测控制性降压对俯卧位脊柱手术全麻患者眼内压及眼底动脉血液动力学的影响，以探讨其安全阈值。方法随机选取预行俯卧位脊柱全麻手术的60例外科患者为研究对象，麻醉过程中采用硝酸甘油控制性降压。选择诱导前10 min（T0）、诱导后10 min（T1）、俯卧位后10 min（T2）、控制性降压10％（T3）、20％（T4）、30％（T5）、恢复正常血压10 min（T6）、术毕平卧位后10 min（T7）、拔出气管导管后10 min（T8）9个时间点，使用笔式眼压计测量眼内压（IOP），使用彩色多普勒超声仪测定右眼视网膜中央动脉和睫状后动脉的血流动力学特征收缩期最高流速（ PSV）、舒张末期最低流速（EDV）、阻力指数（RI）及搏动指数（PI）。结果患者诱导麻醉后，IOP、RI 及 PI 随着麻醉时间的延长呈升高趋势，PSV 及 EDV 呈降低趋势，T5时，各指标差异性最大，均较 T0有显著差异（ P ﹤0.05或﹤0.001）。T6后，各指标有所恢复，T8各指标较 T0无统计学差异（ P ﹥0.05）。另外，T5时4例患者出现视网膜中央动脉闭塞（CRAO）征象，其 MAP 均低于患者该时段平均水平（64.8±8.66 mmHg）。结论控制性降压对俯卧位脊柱手术全麻患者的眼内压及眼底动脉血液动力学指征有所影响，血压降低水平控制在基线水平的30％以内，且保证目标 MAP ﹥65 mmHg，可有效保护患者视神经。
목적：실시감측공제성강압대부와위척주수술전마환자안내압급안저동맥혈액동역학적영향，이탐토기안전역치。방법수궤선취예행부와위척주전마수술적60예외과환자위연구대상，마취과정중채용초산감유공제성강압。선택유도전10 min（T0）、유도후10 min（T1）、부와위후10 min（T2）、공제성강압10％（T3）、20％（T4）、30％（T5）、회복정상혈압10 min（T6）、술필평와위후10 min（T7）、발출기관도관후10 min（T8）9개시간점，사용필식안압계측량안내압（IOP），사용채색다보륵초성의측정우안시망막중앙동맥화첩상후동맥적혈류동역학특정수축기최고류속（ PSV）、서장말기최저류속（EDV）、조력지수（RI）급박동지수（PI）。결과환자유도마취후，IOP、RI 급 PI 수착마취시간적연장정승고추세，PSV 급 EDV 정강저추세，T5시，각지표차이성최대，균교 T0유현저차이（ P ﹤0.05혹﹤0.001）。T6후，각지표유소회복，T8각지표교 T0무통계학차이（ P ﹥0.05）。령외，T5시4례환자출현시망막중앙동맥폐새（CRAO）정상，기 MAP 균저우환자해시단평균수평（64.8±8.66 mmHg）。결론공제성강압대부와위척주수술전마환자적안내압급안저동맥혈액동역학지정유소영향，혈압강저수평공제재기선수평적30％이내，차보증목표 MAP ﹥65 mmHg，가유효보호환자시신경。
Objective To explore the safe threshold of controlled hypotension in prone position spinal surgery by real - time monitoring of intraocular pressure(IOP)and hemodynamic changes. Methods Sixty patients prepared for prone position spinal surgery were selected and con-trolled hypotension with nitroglycerin during anesthesia. Nine time points(T0 ~ T8)were selected to detect IOP and hemodynamic indexes with to-nometer and color doppler flow imaging. Results After the induction of anesthesia,IOP,resistance index(RI)and pulsatility index(PI)in-creased while peak systolic velocity(PSV)and end diastolic velocity(EDV)decreased as time went by;and all the indexes changed mostly at T5,which were all different significantly compared to T0( P ﹤ 0. 05 or P ﹤ 0. 001). After the extubation,all indexes restored as time went by;and there was no significant difference between those at T8 and T0( P ﹥ 0. 05). Further more,there were 4 cases of central retinal artery occlu-sion(CRAO)at T5,in which arterial pressure was lower than the average level(64. 8 ± 8. 66 mmHg). Conclusion Controlled hypotension in prone position spinal surgery has certain effect on the intraocular pressure and hemodynamic indexes,and we should control the hypotensive per-centage in the scope of 30% and ensure the mean arterial pressure not less than 65 mmHg to protect the patient′s optic nerve.