限制性与开放性液体方案对俯卧位脊柱手术患者眼部参数的影响：一项随机对照试验。
The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial.
作者信息
Yang Xiao-Yu, Wei Miao-Miao, Tan Hong, Wang Hai-Lian, Luo Meng-Qiang, Xu Ming, Wang Ying-Wei
机构信息
Department of, Anaesthesiology, Huashan Hospital Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
出版信息
Perioper Med (Lond). 2023 Jun 12;12(1):23. doi: 10.1186/s13741-023-00310-6.
BACKGROUND
Elevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position.
METHODS
A single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer's lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13-16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position.
RESULTS
A total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05).
CONCLUSIONS
Compared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery.
TRIAL REGISTRATION
The study was registered in ClinicalTrials.gov ( https://clinicaltrials.gov ) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.
背景
俯卧位手术期间眼压升高和视神经水肿可能导致眼和视神经缺血性损伤。我们假设，对于俯卧位患者，宽松的液体输注方案可能比限制性液体输注方案更能进一步增加眼压和视神经鞘直径（ONSD）。
方法
进行了一项单中心、前瞻性随机试验。患者被随机分为两组：宽松液体输注组，给予重复推注乳酸林格氏液以维持脉压变异度（PPV）在6%至9%之间；限制性液体输注组，将PPV维持在13%至16%之间。在仰卧位麻醉诱导后10分钟、俯卧位摆放后10分钟、俯卧位摆放后1小时和2小时、手术结束时以及恢复仰卧位时测量双眼的眼压和ONSD。
结果
共招募了97例患者并完成了研究。在宽松液体输注组，眼压从仰卧位时的12±3mmHg显著增加至手术结束时的31±5mmHg（p<0.001），在限制性液体输注组从12±2mmHg增加至28±4mmHg（p<0.001）。两组之间眼压随时间变化存在统计学显著差异（p=0.019）。两组患者ONSD均从仰卧位时的5.3±0.3mm显著增加至手术结束时的5.5±0.3mm（均p<0.001）。两组之间ONSD随时间变化无统计学显著差异（p>0.05）。
结论
与限制性液体输注方案相比，宽松液体输注方案增加了俯卧位脊柱手术患者的眼压，但未增加ONSD。
试验注册
该研究在患者入组前已在ClinicalTrials.gov（https://clinicaltrials.gov）注册，编号：NCT03890510，于2019年3月26日注册。主要研究者是杨小玉。
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