1996～2005年美国脊柱外科、骨科、心脏和普外科手术围术期视力丧失的调查研究  

作　　者：Yang Shen Melinda, Drum Steven Roth 

机构地区：[1]Pritzker School of Medicine [2]Anesthesia and Critical Care [3]Health Studies,The University of Chicago, Chicago, Illinois

出　　处：《麻醉与镇痛》2012年第5期43-57,共15页Anesthesia & Analgesia

摘　　要：背景围术期视力丧失（periopera tivevisual loss，POVL）是非眼部手术中是一个罕见的、潜在的、灾难性的并发症，但在普通住院患者手术中的发病率尚不明确。我们拟用全美住院样本来估算POVL在美国8类最常见的非眼部手术中的发病率。方法全美住院样本中有560多万患者在1996—2005年间做过膝关节成形术、胆囊切除术、髋或股骨手术、脊柱融合术、阑尾切除术、直肠结肠切除术、椎板非融合切除术、冠状动脉旁路搭桥术和心脏瓣膜手术。根据国际疾病分类临床修订本第9版规定，POVL包含缺血性视神经病（ishemic optic neuropathy，ION）、皮质盲（cortical blindness，CB）和视网膜血管闭塞（retinal vascular occlusion，RVO）3种。POVL的发病率以这3种疾病来估算，用单因素和多因素分析对潜在的风险因素进行评估。结果心脏手术和脊柱融合术的POVL发病率最高。心脏手术和脊柱融合术在全美的PovL发病率分别为8．64／10000和3．09／10000，与之相比，阑尾切除术则为0．12／10000。行心脏手术、脊柱融合术和骨科手术的患者发展为ION、RVO或CB的风险显著增加。小于18岁的患者发生POVL的风险最高，以CB为主；而大于50岁的患者易发生ION和RVO。其他可预测P0vL的一些阳性诊断指标包括男性、Charlson合并症指数、贫血和输血。医院的手术量并不增加POVL的发病率。在1996-2005年期间，POVL发病率呈总体下降趋势。结论本研究结果证实了心脏手术和脊柱融合术发生POVL的风险较高这一临床猜测，并首次说明了下肢关节置换术患者该并发症的风险性较高。1996—2005年间美国8类最常见手术的POVL发病率呈下降趋势。以男性和Charlson合并症指数评估POVL时，其发病率增加表明POVL的一些风险因素尚未改变。由于资料库中缺乏手术过程中的数据和出院患者的诊断标准不确定等因素，影响数据的准�BACKGROUND： Perioperative visual loss （POVL） accompanying nonocular surgery is a rare and potentially devastating complication but its frequency in commonly performed inpatient surgery is not well defined. We used the Nationwide Inpatient Sample to estimate the rate of POVL in the United States among the eight most common nonocular surgeries. METHODS： More than 5. 6 million patients in the Nationwide Inpatient Sample who underwent principal procedures of knee arthroplasty, cholecystectomy, hip/femur surgical treatment, spinal fusion, appendectomy, colorectal resection, laminectomy without fusion, coronary artery bypass grafting, and cardiac valve procedures from 1996 to 2005 were included. Rates of POVL, defined as any discharge with an International Classification of Diseases, Ninth Revision, Clinical Modification code of ischemic optic neuropathy （ION）, cortical blindness （CB）, or retinal vascular occlusion （RVO）, were estimated. Potential risk factors were assessed by univariate and multivariable analyses. RESULTS： Cardiac and spinal fusion surgery had the highest rates of POVL. The national estimate in cardiac surgery was 8.64/10, 000 and 3.09/10, 000 in spinal fusion. By contrast, POVL after appendectomy was 0. 12/10, 000. Those undergoing cardiac surgery, spinal fusion, and orthopedic surgery had a significantly increased risk of developing ION, RVO, or CB. Patients younger than 18 yr had the highest risk for POVL, because of higher risk for CB, whereas those older than 50 yr were at greater risk of developing ION and RVO. Other significant positive predictors for some diagnoses of POVL were male gender, Charlson comorbidity index, anemia, and blood transfusion. There was no increased risk associated with hospital surgical volume. During the 10 yr from 1996 to 2005, there was an overall decrease in POVL in the procedures we studied. CONCLUSIONS： The results confirm the clinical suspicion that the risk of POVL is higher in cardiac and spine fusion surgery and show for the first time a

关 键 词：外科手术围术期 心脏瓣膜手术 视力丧失 骨科手术 脊柱外科 美国 普通住院患者 冠状动脉旁路搭桥术 

分 类 号：R451[医药卫生—治疗学]