| Objective Although ophthalmologic operation had a little influence on the systemic body of patient, it would increase operation risk that medications, stress, operative stimulus, pain, anesthesia, oculocardiac reflex(OCR) and so on. With the development of medicine and technique, the committed safe factor to the ophthalmologic operation was not operation itself, but the concomitant diseases of the patient, such as cardiovascular disease, diabetes mellitus. Moreover, the transition in patterns of epidemiology, aging and change of disease pedigree in mankind would influence on the concomitant diseases of patient deeply. Therefore, it was necessary to research the change of concomitant diseases of ophthalmologic operation at present. In addition, ophthalmologist should evaluate safety and reliability of phacoemulsification and vitreoretinal operation which were carried out widely, and research the change of blood pressure, OCR and electrocardiogram(ECG) in the two kinds of operations above which were performed on the patient with cardiovascular disease, so as to provide evidence for the management in the peri-operation period.Methods 1. Analyzing retrospectively the transition of epidemiology on the ocular surgery patients in ten years. 2. Patients in phacoemulsification were divided into cardiovascular disease group and control group, topical anesthesia group and retrobulbar anesthesia group, and comparing the changes of blood pressure, OCR and ECG among all groups. 3. Patients in vitreoretinal operation were divided into cardiovascular disease group and control group, anesthesia with epinephrine group and without group.Comparing the changes of blood pressure, OCR and ECG among all groups. 4. Following-up the visual acuity in the cardiovascular disease group and control group after operation.Results 1. Age of patients were 35.4±23.4 and 56.7±19.5 in 1989 and 2000 respectively, ratio of patients with cardiovascular disease was from 18.9% to 68.6% in ten years, it was significant difference (P<0.01). 2. Compared with the mean systolic blood pressure at preoperative phase in phacoemulsification, cardiovascular disease group rose 6.9～18.2mmHg and control group rose 8.3～13.4mmHg during operation. Cardiovascular disease group had a significant rise in systolic blood pressure(P<0.05) at incision and phacoemulsification, the same as control group at all phases beside anesthesia. Compared with topical anesthesia group, retrobulbar anesthesia group had a significant rise in diastolic blood pressure(P<0.05) at incision , phacoemulsification and Irrigation/Aspiration(I/A). The mean time of vitreoretinal operation was 164 minutes which was longer than that of phacoemulsification, but the blood pressure had a little change, and diastolic blood pressure in anesthesia with epinephrine group rose significantly(P<0.05) at anesthesia phase. 3. Ratio of OCR was 17～18% in phacoemulsification and 33～44% in vitreoretinal operation, moreover, it was 13% in topical anesthesia group and 23% in retrobulbar anesthesia group, and the difference was significant. 4. There were new and transient ECG abnormalities during operation, which did not necessarily associate with the preoperative ECG and occurred in retrobulbar anesthesia group mostly. 5. Patients have been followed-up for three months after phacoemulsification, cardiovascular disease group had a worse visual acuity than control group, the difference was significant(P<0.05).Conclusions 1. The concomitant diseases of the ocular surgery patients accorded with the changing of epidemiology. Old people with cardiovasculardisease would be the important group in the ophthalmologic operation, especially in cataract surgery. 2. Blood pressure had a rise tendency during operation. It was beneficial for maintaining stability of blood pressure to apply anesthesia with reinforcement in a long time operation. Topical anesthesia was reliable in cataract phacoemulsification. Proper dosage of epinephrine with anesthesia gave a little influence on blood pressure, but i... |
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