腔镜甲状腺手术中颈部CO2充气对眼内压的影响

摘要

Objective To observe the effect of carbon dioxide ( CO2 ) insufflation on intraocular pressure ( IOP ) during endoscopic thyroidectomy. Methods 30 cases with thyroid neoplasms were divided into two groups; 15 cases underwent endoscopic thyroidectomy (as group A) and 15 cases underwent conventional open thyroidectomy ( as group B). IOP Was measured before anesthesia ( T0) , at 5 min after tracheal intubation ( Tl) , 10 min after CO2 Insufflation (T2) , 20 min after CO2 Insufflation (T3) ,40 min after CO2 Insufflation (T4) and 10 min after CO2 Insufflation cease(T5). And HR, MAP and PETCO2 were recorded at every time point. Results There was no obvious difference in age, gender, operative duration and preoperative IOP between two groups ( P > 0. 05 ). Compare with T0, the IOP decreased at Tl in both two groups ( P < 0.05 ). In group A, IOP increased at T2 to T5 and all was higher than that of T0(P <0.05 ) , and achieve crest value at T4(P < 0. 05). There was no statistic difference in group B. at T2 - T5 points ( P > 0. 05 ). The IOP of group A was remarkable higher than that of group B at T2 to T5. The HR and MAP has no statistic difference in intra-group comparison and comparison between two groups (P >0.05). Both PETCO2 of T3 and T4 was higher than that of TO in group A ( P < 0. 05 ) , and also was higher than those of group B at the same time points ( P < 0. 05). Conclusion The IOP will increase in patietits undergoing endoscopic thyroidectomy, which could be harmful to vision.%目的 观察腔镜甲状腺手术中颈部CO2充气对患者眼压的影响. 方法 甲状腺手术患者30例,根据手术方式分为腔镜手术组(A组)和开放手术组(B组),每组各15例.测量两组麻醉前(T0)、麻醉后5 min(T1)、颈部CO2充气10 min(T2)、20 min( T3)、40 min( T4)及停止充气10 min(T5)各个时点的眼压及心率(HR)、平均动脉压(MAP)及呼气末CO2分压(PETCO2). 结果 ①两组患者的年龄、手术时间及术前眼压无显著性差异.②两组患者麻醉诱导后(T1)眼压较麻醉前(T0)均有所下降,差异有显著性(P＜0.05).A组患者在颈部充气后眼压呈逐渐上升的趋势,T4时达到最高.手术结束颈部排气10 min后(T5)眼压较T4下降(P＜0.05),仍高于T0.B组患者手术开始后各时点眼压无显著差异(P＞0.05).T2～T5各时点两组间比较有显著性差异,A组均高于B组(P＜0.05).③两组患者HR、MAP的变化无统计学差异(P＞0.05).A组患者在颈部充气20 min、40 min( T3、T4)时PETCO2高于T0(P ＜0.05),T3、T4时A组的PET CO2较B组高(P＜0.05). 结论 腔镜甲状腺手术可导致眼内压显著升高,有发生视力损害的危险.