白内障超声乳化吸除术中高灌注压下眼内血流的变化  

Change of pulsatile ocular blood flow during phacoemulsification surgery with high pressure irrigation

作　　者：王振茂[1] 张铭志[1] 

机构地区：[1]汕头大学.香港中文大学联合汕头国际眼科中心,广东汕头515041

出　　处：《眼科》2013年第2期82-85,共4页Ophthalmology in China

摘　　要：目的探讨高灌注压下白内障超声乳化吸除术时搏动性眼血流的变化及相关影响因素。设计前瞻性非比较性病例系列。研究对象白内障超声乳化吸除术患者23例。方法应用搏动性眼血流分析仪分别在手术前、手术中动态测量眼内搏动性眼血流参数,包括搏动性眼血流量(POBF)、脉搏周期内平均眼压等,心电监护仪记录心率及血压。术前基线观察点为手术开始置开睑器后,术中超声乳化阶段及皮质抽吸阶段各测量1次。分析年龄、眼压、心率和血压与POBF的相关性。主要指标搏动性眼血流量,眼压。结果患者术前基线、超声乳化阶段、皮质抽吸阶段测得的搏动性眼血流量分别为(16.43±6.52)、(12.36±9.60)、(8.24±6.55)μl/秒。与术前基线相比,术中超声乳化及皮质抽吸时的搏动性眼血流量均有不同程度下降。在皮质抽吸时搏动性眼血流量较超声乳化时进一步下降,与基线值相比差异均有统计学意义(P均<0.001)。患者术前基线、超声乳化阶段、皮质抽吸阶段的平均眼压分别为(21.10±4.10)、(59.64±13.83)、(39.72±10.04)mm Hg。与术前基线眼压相比,术中两个观察点的眼压明显升高,且均有统计学意义(P均<0.05)。患者年龄和眼压与POBF呈负相关(b=-0.068,P<0.001和b=-0.012,P<0.001),心率和收缩压与POBF呈正相关(b=0.005,P=0.046;b=0.007,P<0.001)。结论白内障超声乳化手术在高灌注压的持续作用下,眼压明显升高,搏动性眼血流持续下降,提示持续高灌注压下的白内障超声乳化手术可造成眼内的血供减少。Objective To investigate in vivo the change of pulsatile ocular blood flow （POBF） and relative parameters during phacoemulsification phases with high pressure irrigation. Design Prospective non-comparative case series. Participants Twenty three patients with cataract who underwent phacoemulsification surgery. Methods A total of 23 patients with cataract who underwent phacoemulsification were included. POBF was assessed using a POBF analyzer. The parameters included POBF and average-lOP. POBF was measured 3 times： before surgery as baseline, during phacoemulsification phase and I/A phase. Blood pressure and heart rate were recorded by the ECG monitor when POBF was measured. POBF changes, IOP and the relation between age, IOP, heart rate, blood pressure and POBF were analyzed. Main Outcome Measures POBF, IOP. Results The POBF measured at baseline, during the phacoemulsification and I/A phases were 16.43±6.52, 12.36±9.60 and 8.24±6.55 μl/sec, respectively. Compared with baseline, POBF decreased during the phacoemulsification phase and continue to decrease further during I/A phase. There was a statistically significant difference between POBF at baseline and during the I/A phase （all P〈0.001）. The average-IOP measured at baseline, during the phacoemulsification and I/A phases were 21.10±4.10 mm Hg, 59.64±13.83 mm Hg and 39.72±10.04 mm Hg, respectively. The highest IOP measured in the 3 phases was during the phacoemulsification phase （59.64±13.83 mm Hg）. Compared with baseline, IOP measured in the 2 surgery phases increased significantly （all P〈0.05）. POBF was found to decrease with increasing age or IOP. POBF also increased as heart rate or systolic blood pressure increased. Conclusion The present study indicated that as lOP rose during phacoemulsification surgery, POBF continued to decrease. This suggested that phacoemulsification surgery might cause ocular ischemia with high pressure irrigation.

关 键 词：白内障超声乳化吸除术 搏动性眼血流 眼压 

分 类 号：R779.66[医药卫生—眼科]