俯卧位脊柱手术后眼部并发症的临床分析

Ocular complications in patients undergoing spine surgeries in prone position

目的分析并讨论俯卧位全身麻醉脊柱手术患者术后眼部并发症的种类及相关危险因素。方法选择2021年01月~2022年10月期间本院脊柱外科在全身麻醉下行脊柱后路手术的患者1182例,统计眼部并发症人数及种类,将之纳入并发症组;根据分层随机方法,选择相同手术部位的无眼部并发症者纳入对照组。比较两组患者年龄、体质量指数(body mass index,BMI)、手术时间、手术出血量、手术部位、基础疾病史等可能的风险因素。结果共39例患者发生术后眼部并发症,其中21例出现暴露性角膜炎,10例眼眶水肿,7例眼部压伤,1例后部缺血性视神经病变(posterior ischemic optic neuropathy,PION)。与对照组相比,并发症组手术时间长、出血量多、血压水平较高(P<0.05),而两组年龄、BMI无明显差异。相比于其他手术,颈椎后路手术眼部病并发症多发。结论俯卧位脊柱手术术后眼科并发症发生较少,但是对于病患生活影响较大,通过研究相关的风险因素,为其早期诊断及治疗提供了借鉴。

Objective To describe and analyze ocular complications and their risk factors associated with spine surgeries in the prone position.Methods From January 2021 to October 2022,39 cases with ocular complications were selected from the patients who underwent posterior spinal surgery under general anesthesia as the ocular complications group,and 39 cases were randomly selected from the remaining as the control group.Risk factors such as age,body mass index(BMI),other underlying diseases,time,location,and blood loss of spinal surgery were compared and researched between the two groups.Results The majority of ocular complaints in the ocular complications group were ocular stinging,photophobia,tearing and foreign body sensation.Among them,21 cases acted as exposure keratitis.10 cases manifested as periorbital or conjunctival edema.7 cases complained of periorbital discomfort,including bruising,redness,and broken skin.One patient had recoverable severe vision loss and was diagnosed with posterior ischemic optic neuropathy(PION).Compared with the control group,the ocular complaints were more frequent with advanced age,history of hypertension,longer surgery time or more blood loss.Posterior cervical spine surgery was more likely to cause ocular complaints than other methods.Conclusion Even fewer ocular complications can be found in spine surgeries in the prone position,but these can induce serve discomforts.This research on ocular complications related risk factors may hopefully guide the diagnosis and treatment strategies.