華盛頓大學(xué)的Lori Lee博士等近日在《麻醉學(xué)》（Anesthesiology）雜志發(fā)表論文稱,，男性和肥胖者在脊柱手術(shù)后更易發(fā)生失明,。該研究小組通過病例對(duì)照研究發(fā)現(xiàn)，男性,、肥胖等與脊柱融合術(shù)后缺血性視神經(jīng)病變相關(guān)的6個(gè)危險(xiǎn)因素,。作者稱，這些危險(xiǎn)因素若被消除或改變,，將有望降低脊柱術(shù)后失明的發(fā)病率,。
缺血性視神經(jīng)病變導(dǎo)致視力下降是脊柱融合術(shù)后的一個(gè)罕見并發(fā)癥，患者的視力可下降至視物模糊至完全失明,，其發(fā)病率約為0.017%至0.1%,，且視力下降不可逆轉(zhuǎn)。
Lee等人對(duì)80名發(fā)生了術(shù)后缺血性視神經(jīng)病變的患者和315名未發(fā)生該并發(fā)癥的患者進(jìn)行了病例對(duì)照研究,。在單變量模型中發(fā)現(xiàn),，男性、肥胖,、糖尿病,、使用Wilson框架、麻醉時(shí)間,、估計(jì)失血量,、血壓低于40%基線水平且持續(xù)時(shí)間大于30分鐘這6個(gè)因素與術(shù)后失明有關(guān)。此外,，較高的置換總量和非血液置換總量也會(huì)增加發(fā)生該并發(fā)癥的風(fēng)險(xiǎn),。
與此相反，較高的最低點(diǎn)比容和較高的膠體置換比例可相應(yīng)降低發(fā)生缺血性視神經(jīng)病變的風(fēng)險(xiǎn),。
在多變量模型中,，仍有6個(gè)因素與術(shù)后失明的發(fā)生相關(guān)，它們分別是：男性,、肥胖,、使用Wilson框架、麻醉時(shí)間,、估計(jì)失血量,、膠體置換比例。
最后經(jīng)過交叉驗(yàn)證顯示,，術(shù)后失明與高齡,、高血壓,、動(dòng)脈硬化、吸煙,、糖尿病無關(guān),。
研究者指出，這些發(fā)現(xiàn)表明術(shù)后缺血性視神經(jīng)病變與書中生理變化關(guān)系較為密切,，而同術(shù)前已患疾病或血管病變關(guān)系不大,。而上述所以危險(xiǎn)因素均可增加術(shù)中患者腹腔、胸腔及眼內(nèi)壓力,，這或許與該并發(fā)癥的發(fā)生有關(guān),。（生物谷bioon.com）
doi:10.1097/ALN.0b013e31823d012a
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PMID:
Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery
The Postoperative Visual Loss Study Group.
Background: Perioperative visual loss, a rare but dreaded complication of spinal fusionsurgery, is most commonly caused by ischemic optic neuropathy (ION). The authors sought to determine risk factors for ION in this setting.
Methods: Using a multicenter case-control design, the authors compared 80 adult patients with ION from the American Society of Anesthesiologists Postoperative Visual Loss Registry with 315 adult control subjects without ION after spinal fusion surgery, randomly selected from 17 institutions, and matched by year of surgery. Preexisting medical conditions and perioperative factors were compared between patients and control subjects using stepwise multivariate analysis to assess factors that might predict ION.
Results: After multivariate analysis, risk factors for ION after spinal fusion surgery included male sex (odds ratio [OR] 2.53, 95% CI 1.35-4.91, P = 0.005), obesity (OR 2.83, 95% CI 1.52-5.39, P = 0.001), Wilson frame use (OR 4.30, 95% CI 2.13-8.75, P < 0.001), anesthesia duration (OR per 1 h = 1.39, 95% CI 1.22-1.58, P < 0.001), estimated blood loss (OR per 1 l = 1.34, 95% CI 1.13-1.61, P = 0.001), and colloid as percent of nonblood replacement (OR per 5% = 0.67, 95% CI 0.52-0.82, P < 0.001). After cross-validation, area under the curve = 0.85, sensitivity = 0.79, and specificity = 0.82.
Conclusions: This is the first study to assess ION risk factors in a large, multicenter case-control fashion with detailed perioperative data. Obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration were significantly and independently associated with ION after spinal fusionsurgery.
