周围手术性缺血性视神经病变:对麻醉影响,血液动力学病理生理学和风险分层的全面审查
Arvind Surya1, Samer Salman2, Rohan Phadke2
1School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. arvind.surya@bcm.edu.
International ophthalmology
|March 14, 2026
概括
由于缺血性视神经病变 (ION) 的外科手术视力损失 (POVL) 是罕见但严重的. 它通常源于视神经血流减少,这是由于手术期间的低血压和高眼压造成的.
科学领域:
- 眼科医生 眼科 眼科
- 麻醉学 麻醉学
- 神经外科 神经外科
背景情况:
- 术后视力丧失 (POVL) 是非眼科手术的罕见但破坏性并发症,主要是由缺血性视神经病变 (ION) 引起的.
- 脊椎和心脏手术最常涉及,观察到前部 (AION) 和后部 (PION) ION的不同模式.
研究的目的:
- 审查外科手术期间缺血视神经病变的机制和危险因素.
- 综合当前的证据,以了解和预防手术后的视力丧失.
主要方法:
- 对流行病学研究,ASA POVL注册表,行政数据库和生理学调查进行叙述性审查.
- 重点是视神经解剖学,眼球 perfusion 压力,眼内压力和风险因素分析.
主要成果:
- 视神经的脆弱性与有限的附带循环和解剖学约束有关.
- 支持 perfusion-failure模型,其中降低的平均动脉压,贫血和升高的眼内/静脉压会降低眼内 perfusion 压力.
- 脊柱手术中的PION与手术持续时间,倾斜的定位,静脉拥堵,肥胖,失血和促进的液体策略有关.
- 心脏外科手术中的AION与血管疾病和低血压有关;栓塞是一个不太常见的原因.
结论:
- 外科手术期间的ION通常是由于全球视神经的低 perfusion,而不是焦点阻塞.
- 了解不同的病理生理机制对于预防至关重要.
- 维持眼球输液压力的策略,减少静脉拥堵和,避免低血压是高风险手术的关键.
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