侧卧手术体位对老年患者眼压变化的影响及护理观察要点

目的探讨使用有效的测量工具和在适合的测量时间段采集侧卧手术体位老年患者基础数据,找出患者眼压变化随体位变化的规律,旨在制订有效的护理预防措施。方法选取2019年3—6月在首都医科大学附属北京同仁医院中心手术室完成胸科胸腔镜手术的老年患者31例。使用icare回弹式眼压计分别于患者入手术室后、全身麻醉插管后、侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h、翻身拔管、出室前9个时间点测量双眼眼压,同时记录每个时间点患者的血压、心率数据,记录手术过程中液体出入量、特殊用药等。结果患者侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的血压与入室后比较,差异有统计学意义(P<0.05);不同时间点的心率比较,差异无统计学意义(P>0.05)。麻醉插管后患者双眼眼压均低于入室时眼压,差异有统计学意义(P<0.05);侧卧30 min、术中1 h、术中2 h、术中3 h的双眼眼压与入室后眼压比较,差异有统计学意义(P<0.05);侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的受压侧眼压与非受压侧眼压比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者平均动脉压与受压侧眼及非受压侧眼的眼压均无相关性(r值分别为-0.1138、0.0179,P>0.05)。进入手术间时患者测试视力与术后6 h回病房后测试视力比较,差异无统计学意义(P>0.05)。结论胸腔镜手术老年患者的眼压随手术体位变化而波动,从侧卧5 min开始眼压出现变化,2 h内受压侧眼眼压达到高峰,体位恢复平卧位后,眼压随即恢复到入室时水平。本研究未发现血压与眼压变化的相关性。

Effect of side-lying operative position on changes of intraocular pressure in elderly patients and nursing observation points

Objective To collect the basic data of elderly patients in side-lying operative position by use of effective measurement tools and appropriate measurement periods and find out the law of changes in intraocular pressure of patients with changes in body position so as to develop effective nursing preventive measures.Methods A total of 31 elderly patients who completed thoracic thoracoscopic surgery in Central Operating Room of Beijing Tongren Hospital Affiliated to Capital Medical University from March to June 2019 were selected as research objects.The icare rebound tonometer was used to measure binocular intraocular pressure at 9 time points,including after entering the room,after intubation under general anesthesia,sidelying operative position for 5 minutes,side-lying operative position for 30 minutes,1 hour during operation,2 hours during operation,3 hours during operation,turning over and extubation and before leaving the room.At the same time,the data of blood pressure and heart rate of the patients at each time point were recorded,and the amount of liquid intake and output during the operation and special medication were recorded.Results Blood pressure of patients in side-lying operative position for 5 minutes,side-lying operative position for 30 minutes,1 hour during operation,2 hours during operation,3 hours during operation was statistically significantly different from that before surgery(P<0.05).The difference of heart rate at different time points was not statistically significant(P>0.05).After anesthesia intubation,binocular intraocular pressure of patients was lower than that before entering the room,and the difference was statistically significant(P<0.05).Binocular intraocular pressures of patients in side-lying operative position for 30 minutes,1 hour during operation,2 hours during operation and 3 hours during operation were statistically significantly differ from that before operation(P<0.05).There were statistically significant differences in intraocular pressure of the compressed side and the non-compressed side of patients in side-lying operative position for 5 minutes,side-lying operative position for 30 minutes,1 hour during operation,2 hours during operation,3 hours during operation(P<0.05).Pearson correlation analysis showed that there was no correlation between the mean arterial pressure of patients and intraocular pressure of the compressed side eye or the non-compression side eye(r=-0.1138,0.0179;P>0.05).There was no statistically significant difference between the visual acuity measured when entering the room and the visual acuity measured after returning to the ward in 6 hours after surgery(P>0.05).Conclusions The intraocular pressure of elderly patients undergoing thoracoscopic surgery fluctuates with the change of the surgical position.From the side-lying operative position for 5 minutes,the intraocular pressure changes,and the intraocular pressure of the compressed side eye reaches a peak within 2 hours.After the posture is restored to the supine position,intraocular pressure immediately returns to the level at the time of entering the room.This study does not find a correlation between blood pressure and changes in intraocular pressure.