华盛顿大学的Lori Lee博士等近日在《麻醉学》（Anesthesiology）杂志发表论文称，男性和肥胖者在脊柱手术后更易发生失明。该研究小组通过病例对照研究发现，男性、肥胖等与脊柱融合术后缺血性视神经病变相关的6个危险因素。作者称，这些危险因素若被消除或改变，将有望降低脊柱术后失明的发病率。
缺血性视神经病变导致视力下降是脊柱融合术后的一个罕见并发症，患者的视力可下降至视物模糊至完全失明，其发病率约为0.017%至0.1%，且视力下降不可逆转。
Lee等人对80名发生了术后缺血性视神经病变的患者和315名未发生该并发症的患者进行了病例对照研究。在单变量模型中发现，男性、肥胖、糖尿病、使用Wilson框架、麻醉时间、估计失血量、血压低于40%基线水平且持续时间大于30分钟这6个因素与术后失明有关。此外，较高的置换总量和非血液置换总量也会增加发生该并发症的风险。
与此相反，较高的最低点比容和较高的胶体置换比例可相应降低发生缺血性视神经病变的风险。
在多变量模型中，仍有6个因素与术后失明的发生相关，它们分别是：男性、肥胖、使用Wilson框架、麻醉时间、估计失血量、胶体置换比例。
最后经过交叉验证显示，术后失明与高龄、高血压、动脉硬化、吸烟、糖尿病无关。
研究者指出，这些发现表明术后缺血性视神经病变与书中生理变化关系较为密切，而同术前已患疾病或血管病变关系不大。而上述所以危险因素均可增加术中患者腹腔、胸腔及眼内压力，这或许与该并发症的发生有关。（生物谷bioon.com）
doi:10.1097/ALN.0b013e31823d012a
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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.
