全身麻醉下机械通气对人体眼内压的影响  

Influence of Mechanical Ventilation on Intraocular Pressure in Human Body Under General Anesthesia

作　　者：周玉旺[1] 李杰[1] 孟翠萍[1] 吴为民[1] 

机构地区：[1]河北省廊坊市第四人民医院麻醉科,河北廊坊065700

出　　处：《医学临床研究》2013年第9期1713-1715,共3页Journal of Clinical Research

基　　金：河北省廊坊市科技支撑计划项目（项目编号：2013013039）

摘　　要：【目的】探讨全身麻醉下机械通气对人体眼内压（10P）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IIPPV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5cmH20及10CIIIH20时，IOP分别从通气前的（2．0±0．3）kPa升至通气30rain后的（2．6±0．2）kPa和通气前的（2．0±0．4）kPa升至通气30min后的（3．0±0．4）kPa，PEEP较IPPV对IOP造成的影响更大（P〈O．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10cmH2O，以避免严重并发症的发生。[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 20]2 to Oct. 2012 were selected. In preoperative examination, all patients had no abnormal heart, lung, liver and kidney {unction and the history of eye disease. Genera[ 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 5cmH20 and 10 cmH2O, the IOP increased from （2.0 ± 0.3）kPa 30min before ventilation to （2.6 ±0.2）kPa 30rain after venti- lation, and （2.0＋0.4）kPa 30rain before ventilation to （3.0±0.4） kPa 30rain after ventilation. The effect of PEEP on lOP was more significant. CVP was positively correlated with IOP（r= 0.81, P 〈0.05）. [Conclusion] 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 10cmH2O in order to avoid serious complications.

关 键 词：眼内压 麻醉 全身 呼吸 人工 

分 类 号：R614[医药卫生—麻醉学]