机器人辅助全膀胱切除术中患者头低足高位对眼压的影响

Effects and influencing factors of trendelenburg position on intraocular pressureduring robotic-assisted radical cystectomy

目的探讨机器人辅助根治性全膀胱切除术中患者头低足高位对眼压的影响并分析其影响因素。方法对41例机器人辅助根治性全膀胱切除术患者,测量平卧位麻醉诱导后10 min内(T1),头低足高位后10 min内(T2)、1 h(T3)、2 h(T4)、3 h(T5),体位恢复水平位后10 min内(T6)和2 h(T7)的眼压。记录患者的一般资料、头低足高位持续时间和角度等。结果头低足高位期间眼压为(24.88±2.61)mm Hg,高于正常眼压值。头低足高位期间眼压值均高于水平位,且随着时间延长,眼压明显升高。多元线性回归分析结果显示,头低足高位持续时间、角度和术中失血量为眼压变化的影响因素,可共同解释眼压61.2%的变异。结论机器人辅助根治性全膀胱切除术中头低足高位使患者术中眼压升高。

Objective To explore the effects of trendelenburg position on intraocular pressure during robotic-as- sisted radical cystectomy and to analyze its influencing factors. Methods Forty-one patients scheduled for robotic- assisted radical cystectomy were included. Perioperative IOP measurements were performed as follows：10 rain after anesthesia induction with supine position（Tl）,10 rain after maintaining trendelenburg position（T2）,1h,2 h and 3 h after maintaining Trendelenburg position （T3,T4,T5）,10 min after supine position （T6）,2 h after supine position（T7）. Gender,age,BMI,duration and angle of trendelenburg position,and blood loss were recorded. Results Mean IOP after trendelenburg position was 24.88±2.61 mmHg,which was higher than normal. Mean IOP in Trendelenburg posi- tioning were significantly higher than those at T1,T6,T7,and IOP increased with time.The influencing factors of IOP included duration and degree of Trendelenburg position,and blood loss. Conclusion IOP increased in patients under- going robotic-assisted radical cystectomy in Trendelenburg position.