Roth S, Thisted R A, Erickson J P, Black S, Schreider B D
Department of Anesthesia and Critical Care, University of Chicago, Illinois 60637, USA.
Anesthesiology. 1996 Nov;85(5):1020-7. doi: 10.1097/00000542-199611000-00009.
Eye injuries after anesthesia, although infrequent, may result in visual impairment. Previous studies have not defined the risk factors associated with these injuries. To study the cause of these injuries and to determine incidence data, the authors reviewed the records from a 4.5-y period of patients who sustained eye injuries after anesthesia and nonocular surgery.
The records were surveyed of 60,965 patients who underwent anesthesia for nonocular surgery at our institution from January 1988 to July 1992. Eye injuries were identified by examining several sources of information, including quality improvement data, postoperative visits or telephone calls, and examination of medical records of postoperative patients who required an ophthalmology consultation. Records were reviewed to determine the types and causes of eye injuries. Logistic regression, with univariate and multivariate analysis, was used to identify the importance of possible risk factors.
Of 34 patients who sustained eye injuries (0.056%), the most common was corneal abrasion (n = 21). Other injuries were conjunctivitis, blurred vision, red eye, chemical injury, direct trauma, and blindness. Independent factors associated with a higher relative risk of eye injury were long surgical procedures (odds ratio, 1.16 per hour of anesthetic care; CI, 1.1 to 1.3), lateral positioning during surgery (odds ratio, 4.7; CI, 2 to 11), operation on the head or neck (odds ratio, 4.4; CI, 2.2 to 9.0), general anesthesia (odds ratio, 3.0; CI, 2.2 to 38), and surgery on a Monday (odds ratio, 2.7; CI, 1.4 to 5.3). In only 21% of cases was a specific cause of injury identified.
For reasons not understood, eye injuries are more common in patients who are older or who undergo lengthier procedures. The cause of injury was usually not determined by the authors' methods. Until the mechanisms producing perioperative eye injuries are better understood, it is difficult to identify strategies to prevent this type of injury.
麻醉后眼部损伤虽不常见，但可能导致视力损害。既往研究尚未明确与这些损伤相关的危险因素。为研究这些损伤的原因并确定发病率数据，作者回顾了4.5年期间麻醉及非眼科手术后发生眼部损伤患者的记录。
调查了1988年1月至1992年7月在本机构接受非眼科手术麻醉的60965例患者的记录。通过检查多种信息来源来确定眼部损伤，包括质量改进数据、术后访视或电话随访，以及对需要眼科会诊的术后患者病历的检查。回顾记录以确定眼部损伤的类型和原因。采用单因素和多因素分析的逻辑回归来确定可能危险因素的重要性。
在34例发生眼部损伤的患者中（0.056%），最常见的是角膜擦伤（n = 21）。其他损伤包括结膜炎、视力模糊、眼红、化学伤、直接创伤和失明。与眼部损伤相对风险较高相关的独立因素包括手术时间长（每小时麻醉护理的比值比为1.16；可信区间为1.1至1.3）、手术期间侧卧位（比值比为4.7；可信区间为2至11）、头颈部手术（比值比为4.4；可信区间为2.2至9.0）、全身麻醉（比值比为3.0；可信区间为2.2至38）以及周一手术（比值比为2.7；可信区间为1.4至5.3）。仅在21%的病例中确定了具体的损伤原因。
由于不明原因，眼部损伤在年龄较大或手术时间较长的患者中更为常见。作者的方法通常无法确定损伤原因。在更好地理解围手术期眼部损伤的发生机制之前，很难确定预防此类损伤的策略。
