Yu Han-Dung, Chou An-Hsun, Yang Min-Wen, Chang Chee-Jen
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
Acta Anaesthesiol Taiwan. 2010 Sep;48(3):122-9. doi: 10.1016/S1875-4597(10)60043-4.
Perioperative eye injuries, although rare, often lead to great discomfort and anxiety for patients. The purpose of this study was to explore the incidence and related risk factors of perioperative eye injuries.
We retrospectively analyzed the records of inpatients who underwent nonocular surgery under general anesthesia with intubation between October 2006 and December 2008. Incidents of eye injuries were extracted from the Department of Anesthesiology Quality Assurance Database of Chang Gung Memorial Hospital. Univariate analysis and logistic regression modeling were used to assess the risk factors.
A total of 75,120 cases were included in the study, of whom 17 (0.023%) were identified to have sustained perioperative eye injury. Corneal abrasion was the most common form of eye injury (10 patients; 59%). Patients who had been operated on in the prone position [odds ratio (OR), 10.8; 95% confidence interval (CI), 2.4-48.8] or lateral position (OR, 7.1; 95% CI, 1.2-43.2), those who had undergone head and neck surgery (OR, 9.3; 95% CI, 2.3-38.0), sustained intraoperative deliberate hypotension (OR, 8.7; 95% CI, 2.4-31.8), or who had preoperative anemia (OR, 5.3; 95% CI, 1.8-15.4) were more susceptible to eye injuries. The duration of anesthesia was not an independent risk factor (OR per hour, 0.9; 95% CI, 0.8-1.7).
In addition to head and neck surgery, operations in the lateral or prone position, preoperative anemia and intraoperative deliberate hypotension are also precipitating factors for perioperative eye injuries. For patients who are at high risk or for procedures that are apt to cause injury, preoperative recognition and intraoperative caution are of paramount importance.
围手术期眼部损伤虽罕见，但常给患者带来极大不适和焦虑。本研究旨在探讨围手术期眼部损伤的发生率及相关危险因素。
我们回顾性分析了2006年10月至2008年12月期间在全身麻醉下经气管插管进行非眼科手术的住院患者记录。眼部损伤事件从长庚纪念医院麻醉科质量保证数据库中提取。采用单因素分析和逻辑回归模型评估危险因素。
本研究共纳入75120例患者，其中17例（0.023%）被确定发生围手术期眼部损伤。角膜擦伤是最常见的眼部损伤形式（10例患者；59%）。接受俯卧位手术的患者[比值比（OR），10.8；95%置信区间（CI），2.4 - 48.8]或侧卧位手术的患者（OR，7.1；95% CI，1.2 - 43.2）、接受头颈手术的患者（OR，9.3；95% CI，2.3 - 38.0）、术中发生故意性低血压的患者（OR，8.7；95% CI，2.4 - 31.8）或术前贫血的患者（OR，5.3；95% CI，1.8 - 十五点四）更容易发生眼部损伤。麻醉持续时间不是独立危险因素（每小时OR，0.9；95% CI，0.8 - 1.7）。
除了头颈手术外，侧卧位或俯卧位手术、术前贫血和术中故意性低血压也是围手术期眼部损伤的诱发因素。对于高危患者或易于造成损伤的手术，术前识别和术中谨慎至关重要。
