体外循环及选择性脑灌注状态下眼压的变化及意义  

Changes and significance of intraocular pressure during cardiopulmonary bypass and selective cerebral perfusion

作　　者：唐瑜[1] 高峰[2] 白晶[1] 郭涛[1] 何学志[2] 庄熙晶[2] 丁学前 TANG Yu;GAO Feng;BAI Jing;GUO Tao;HE Xue-zhi;ZHUANG Xi-jing;DING Xue-qian(Department of Ophthalmology,Dalian Municipal Central Hospital,Liaoning Province,Dalian 116033,China;Department of Cardiovascular Surgery,Dalian Municipal Central Hospital,Liaoning Province,Dalian 116033,China;Department of Cardiopulmonary Bypass,Dalian Municipal Central Hospital,Liaoning Province,Dalian 116033,China)

机构地区：[1]大连市中心医院眼科,辽宁大连116033 [2]大连市中心医院心脏大血管外科,辽宁大连116033 [3]大连市中心医院体外循环科,辽宁大连116033

出　　处：《中国当代医药》2021年第5期155-158,162,共5页China Modern Medicine

基　　金：辽宁省大连市医学科学研究计划项目(1811019)。

摘　　要：目的观察在温度、血压不同的体外循环前、体外循环中及选择性脑灌注、恢复循环时眼压变化规律。方法选取2018年12月~2020年9月于大连市中心医院诊断的Stanford A型主动脉夹层、具有手术指征行升主动脉及主动脉弓置换联合冰冻象鼻手术的患者作为研究对象,记录一般情况,测量术中降温、选择性脑灌注、恢复循环以及复温过程(温度点同降温)中各时间点眼压,并进行分析。结果共观察21例患者,男15例(71.4%),女6例(28.6%)。所有患者均有高血压病史,无青光眼家族史。术前及术后床旁眼科查体未见明显异常。降温过程中各温度点眼压比较,差异有统计学意义(P<0.05),眼压随温度下降呈降低趋势;复温过程中各温度点眼压比较,差异有统计学意义(P<0.05),眼压随温度上升呈上升趋势;选择性脑灌注过程中眼压随时间延长呈下降趋势,脑灌注5 min与脑灌注10 min时眼压比较,差异无统计学意义(P>0.05),其余各点差异均有统计学意义(P<0.05);恢复循环过程中眼压随时间延长呈上升趋势,各时间点眼压比较,差异均有统计学意义(P<0.05)。结论温度与血压可对眼压产生影响,眼压与温度和血压呈正相关趋势。Objective To observe the changes of intraocular pressure with different temperature and blood pressure during cardiopulmonary bypass,selective cerebral perfusion and recovery of circulation.Methods Patients who diagnosed of Type A Aortic Dissection with surgical indications underwent ascending aorta replacement and aortic arch replacement combined with frozen elephant trunk surgery in Dalian Municipal Central Hospital from December 2018 to September 2020 were selected as the research objects.General situations were recorded.Intraocular pressure during the operation cooling process,selective cerebral perfusion process,circulation recovery process and rewarming were measured and analyzed.Results A total of 21 patients were observed,including 15 males(71.4%)and 6 females(28.6%).All patients had a history of hypertension and without family history of glaucoma.There was no obvious abnormality in ophthalmic examination before and after operation.During the cooling process,the differences of intraocular pressure at different temperature points were statistically significant(P<0.05),and intraocular pressure decreased with the lowing of temperature.During the rewarming process,the differences of intraocular pressure at each temperature points were statistically significant(P<0.05),and intraocular pressure showed an upward trend with the increase of temperature.During the selective cerebral perfusion process,intraocular pressure showed a downward trend with the extension of time,and there was no difference between 5 minutes and 10 minutes of cerebral perfusion(P>0.05),and in other points,the differences were statistically significant(P<0.05).Intraocular pressure increased with time during the recovery of circulation,and the differences in each points were statistically significant(P<0.05).Conclusion Temperature and blood pressure can affect intraocular pressure.Intraocular pressure is positively correlated with temperature and blood pressure.

关 键 词：眼压 温度 血压 体外循环 选择性脑灌注 

分 类 号：R755[医药卫生—皮肤病学与性病学]