老年高血压患者白内障术中脉压变化的临床分析

Pulse pressure in aged hypertensives during cataract surgeries

目的研究老年高血压患者白内障术中脉压（PP）变化情况，了解白内障手术的心血管损伤风险。方法前瞻性对照研究。对2010年11月至2011年3月在温州医学院附属眼视光医院就诊的白内障手术患者，根据高血压和年龄分为3组：其中老年高血压组（A组）21例（21只眼），老年正常血压组（B组）20例（20只眼）和年轻正常血压组（C组）20例（20只眼）。测量以下时间点的脉压值：入院时（PP1）、进入手术室术前（PP2）、超声乳化白内障时（PP3）、人工晶状体植入前（PP4）、手术结束时（PP，）。同时观察患者术前和术后视力及眼压变化。结果所有患者均顺利完成手术，术后视力均显著提高（t=-5．692，-4．699，-3．204；P〈0．05），手术前后眼压均在正常范围内，差异无统计学意义（t=1．150，0．214，-0．268；P〉0．05）。各时间点脉压依次为：A组（63．00±13．198、77．95±13．08、72．81±17．57、72．81±19．10、73．43±17．98）mmHg；B组（51．25±10．78、65．10±12．49、65．40±10．18、62．75±12．37、63．25±12．21）mmHg；C组（37．25±6．74、57．60±13．19、54．50＋14．61、53．20＋10．01、54．40±12．01）mmHg。在手术不同时间点，脉压值不同（F=36．161，P〈0．05），3组同一时间点脉压值不同（F=17．277，P〈0．05）。PP。从大到小依次为A组、B组、C组（P〈0．05）；A组PP：大于其它组（P〈0．05），B组和c组相似（P〉0．05）；各组PP2比PP1增大（P〈0．05），增大幅度分别为A组（14．59±2．54）mmHg、B组（13．85±3．16）mmHg，C组（20．35±3．60）mmHg，差异均无统计学意义（P〉0．05）；C组PP4测量值低于PP2（P〈0．05），余差异均无统计学意义（P〉0．05）。PP：与年龄、PP，差异有统计学意义（r=0．480，0．563；P〈0．001）。结论白内障手术发生心血管损伤的风险虽然较低，但是高血压是老年人白内障术中发生心脑血管损伤的危险因素。控制并且稳定术前血压、脉压水平，术中心电监护，可降低心血管损伤风险，提高手术安全性。

Objective To evaluate senior hypertensivesl cardiovascular system by pulse pressure （PP） in cataract surgeries. Methods Prospective and case control study. Sixty-one cataract patients were settled to group A （aged, hypertensives）, group B （aged, normoten-sives） or group C （middle-aged, normotensive）. PP measurements were recorded on the day they were hospitalized as base-line （PP,）, just before surgeries started （PP0, during phcaoemulsification （PP3）i before intraocular lens implantation （PP4）, and at the endpoint of the surgeries （PP0. In addition, best corrected visual acuity （BCVA） and intraocular pressures （IOPs） were investigated. Results All patients got an improvement in BCVA after surgery and IOPs were within normal levels. PP1-5 measurements were as follows respectively, （63.00±13.198, 77.95±13.08, 72.81±17.57, 72.81±19.10, 73.43±17.98） mmHg in group A; （51.25±10.78, 65.10±12.49, 65.40±10.18, 62.75±12.37, 63.25±12.21） mmHg in group B, and （37.25±6.74, 57.60±13.19, 54.50±14.61, 53.20±10.01, 54.40±12.01） mmHg in group C. There were significant differences in PP1 measurements among groups （P 〈0.05）. PP2 measurement in group A was the highest （P 〈0.05）, whereas, no significant difference was found in measurements between group B and C （P 〉0.05）. The increases in PP2 measurements were （14.59±2.54, 13.85±3.16, and 20.35±3.60） mmHg, respectively. And no significant difference was found in the increase of PP2 or measurements of PP2-5 among groups. There was a significant correlation of PP1-5 measurements within groups （F =36.161, P 〈0.001）. And no significant difference was found in the main effects among groups （F =0.939, P 〉0.05）. Conclusions This prospective analysis shows that cataract surgery is safe despite being performed in an elderly population. The high levels of PP has important roles in the risk of organ damage to senior hypertensives and measures should been taken in controlling PP for the sake of safety in cataract surgery.