神经外科围术期瞳孔改变的相关因素分析  

Analysis of related factors of perioperative pupil change in neurosurgery

作　　者：赵浩 尚峰 程玮涛[1] 徐跃峤[1] 齐猛[1] 蒋丽丹[1] 陈文劲[1] 王宁[1] 曲鑫 Hao Zhao;Feng Shang;Weitao Cheng;Yueqiao Xu;Meng Qi;Lidan Jiang;Wenjin Chen;Ning Wang;Xin Qu(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经创伤外科电子杂志》2024年第3期147-150,共4页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：首都医科大学校培育基金(PYZ21037)

摘　　要：目的分析神经外科围术期患者瞳孔突然改变的相关因素,评估头颅CT复查的必要性。方法回顾性收集首都医科大学宣武医院神经外科自2020年12月至2024年1月收治的29例神经外科术后突发瞳孔改变的患者为瞳孔变化组,选取同期神经外科术后常规复查头颅CT且无瞳孔变化的29例患者为瞳孔无变化组。收集所有患者的临床资料,采用单因素和多因素Logistic回归分析筛选术后瞳孔变化的潜在影响因素。结果瞳孔变化组和瞳孔无变化组患者的一般资料比较差异无统计学意义(P>0.05)。单因素Logistic回归分析显示性别、气管插管镇静镇痛、使用异丙托溴铵雾化吸入、颅内病情变化与患者突发瞳孔改变无明显关系,意识变化和是否进行临床处理与患者突发瞳孔改变有关。多因素Logistic回归分析显示,患者意识改变和需要临床干预是围术期瞳孔改变的独立危险因素。结论神经外科围术期患者发生瞳孔改变后,伴随意识改变和采取临床干预是其危险因素,需要紧急复查头颅CT,为患者制定个性化治疗方案。Objective To analyze the factors associated with sudden changes in pupil size in neurosurgical perioperative patients and evaluate the necessity of repeat head CT scans.Methods A retrospective collection was conducted of 29 cases of sudden postoperative pupil changes in neurosurgical patients treated at Neurosurgery Department of Xuanwu Hospital,Capital Medical University from December 2020 to January 2024.The control group consisted of 29 neurosurgical patients who underwent routine postoperative head CT scans during the same period without any changes in pupil size.Clinical data were collected,and both univariate and multivariate Logistic regression analyses were performed to identify potential influencing factors for postoperative pupil changes.Results There was no significant difference in general data between the group of patients with pupil changes and the group without pupil changes(P>0.05).Univariate Logistic analysis indicated no significant association between sudden pupil changes and factors such as gender,tracheal intubation with sedation and analgesia,the use of ipratropium bromide nebulization inhalation and intracranial disease changes,however,changes in consciousness and clinical intervention were significantly associated with sudden pupil changes.Multivariate Logistic analysis revealed that changes in consciousness and the need for clinical intervention were independent risk factors for detecting pupil changes.Conclusion Following perioperative pupil changes,accompanying changes in consciousness and the need for clinical intervention are significant risk factors.It is necessary to urgently review the head CT and develop personalized treatment plans for the patients.

关 键 词：瞳孔变化 意识改变 临床干预 头颅CT 神经外科围术期 

分 类 号：R651.1[医药卫生—外科学]