闪光视觉诱发电位的新应用——进行眼眶术中视功能监护  

New application of F-VEP:monitoring the visual function during orbital surgery

作　　者：唐东润[1] 朱豫[1] 宋国祥[1] 翟学智[1] 李艳芳[1] 赵红[1] 

机构地区：[1]天津医科大学第二医院,天津市眼眶病研究所300211

出　　处：《中华眼底病杂志》2001年第4期260-263,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：天津市科委21世纪青年科学基金资助项目 (98370 341 1 )

摘　　要：目的　为了了解眼眶手术中视神经的功能状态 ,及时发现全麻手术中视功能的损伤情况 ,采用闪光视觉诱发电位 (flash visual evoked potential,F- VEP)进行术中视功能监护。　方法　应用视觉电生理检查仪器对 2 82例全麻眼眶手术患者进行了术中监护 ,成功者 2 5 2例 ,在患者术前清醒状态下、全麻下手术前、切除肿瘤时、切除肿瘤后和手术结束时进行 F- VEP检查。　结果　 1全麻下的 F- VEP振幅和潜伏期与清醒状态下无明显差异。2在未损伤视神经的手术操作中 ,其 F- VEP是正常的。3术中牵拉和压迫视神经可产生短暂的波形下降 ,解除牵拉和压迫后可逐渐恢复到正常水平。 4当视神经和它的血液供应严重受损时 ,F- VEP波形立即下降。自开展术中监护以来 ,无一例发生术中意外视力丧失 ,2 4例在术中发现视功能受损 ,及时采取措施挽救了患者的视力。　结论　应用 F- VEP进行眼眶手术的术中监护 ,可减少致盲率 ,使手术操作由临床经验解剖阶段逐步进入功能解剖阶段 ,随着这项技术的不断完善和发展 。Objective To observe the functional state of the optic nerve and discover the injury of visual pathway function in time under general anesthesia. The flash visual evoked potential (F-VEP) was used to monitor visual function during orbital surgery. Methods A total of 252 out of 282 patients undergoing orbital surgery under general anesthesia were successfully monitored by F-VEP during the surgery. All patients were monitored by this method under the following conditions:consious state before operation, under general anaesthesia, during and after dissection of orbital tumor and at the end of operation. Results ①There was no significant difference of wave amplitude and latency under general anesthesia and consciousness condition. ②The amplitude and latency of F-VEP were normal in the orbital surgery without optic nerve injury. ③Pulling and oppression of optic nerve could cause temporary wave loss, but the wave recovered after removal of the pull and oppression. ④ The wave loss of F-VEP would occur immedicately when optic nerve was severe injured and its blood supply was deficient. Since the application of the visual function monitoring, 24 cases were treated in time during disturbance of visual function and no patient has unexpected visual loss during orbital surgery. Conclusion The intraoperative monitoring of F-VEP during orbital surgery can decrease the proportion of permanent visual loss caused by orbital surgery, and help the surgical procedures go to function-anatomy stage from experience-anatomy stage.

关 键 词：闪光视觉诱发电位 眼外科手术 视功能监护 

分 类 号：R779.6[医药卫生—眼科] R770.43[医药卫生—临床医学]