摘要背景 头低位腹腔镜手术中患者眼压(intraocular pressure, IOP)可明显升高,术中IOP过高可能与术后视力丧失(postoperative visual loss, POVL)有关. 目的 针对头低位腹腔镜手术对IOP的影响进行综述,加强对高IOP危害的认识,避免POVL的发生. 内容 阐述IOP升高的危害、头低位腹腔镜手术中影响IOP的因素及预防术中IOP升高的方法与措施.趋向 POVL因发生率低而未引起麻醉医师的足够重视,术中IOP升高也许是导致POVL的机制之一,关注头低位腹腔镜手术中患者IOP,对于预防POVL具有重要意义.

abstractsBackground Patients' intraocular pressure (IOP) significantly increase during laparoscopic surgery in Trendelenburg position, and the resulting intraoperative intraocular hypertension may be related to postoperative visual loss (POVL). Objective To review the impact of laparoscopic surgery in Trendelenburg position on IOP to let the practitioners aware of the association between intraocular hypertension and POVL. Content One of the major causes for POVL is ischemia in optic nerve following reduction of ocular perfusion pressure (OPP) because of the increase of IOP. Animal studies prove that persistently increased IOP leads to damages in the retina. Patients often receive the laparoscopic surgery in Trendelenburg position, and low OPP and high IOP are commonly seen in this situation. In addition to the body position, the increase of IOP can also be a consequence of hypercapnia following CO2inflation in the abdominal cavity, and may be affected by anesthetics, duration of the surgery, blood pressure, obesity and gender, etc. Several procedures have been performed to alleviate the increase of IOP, such as, intermittent shift the Trendelenburg position into supine position and intraoperative pharmacological intervention. Trend POVL is rarely seen in laparoscopic surgery, but severely compromises patient's life quality if happens. Cautions should be taken to carefully monitor IOP in the patients with risk factors for POVL during laparoscopic surgery in the Trendelenburg position.