摘要
目的提高对机械通气诱发青光眼的认识，提高其预防及诊治水平。方法回顾分析北京积水潭医院呼吸科2例于正压机械通气治疗时发生的青光眼病例，并进行相关文献复习。结果2例患者中1例为女性，77岁，近期股骨颈骨折（右），有慢性阻塞性肺疾病20余年，高血压病史18年，糖尿病史8个月。1例为男性，75岁，肺间质纤维化2年，胃溃疡病史20余年。2例患者均否认青光眼病史及家族史。主要症状和体征为2例患者于应用正压机械通气治疗时出现眼部发胀、流泪、视力模糊甚至丧失。患侧眼结膜充血、睫状体充血、角膜水肿、瞳孔散大、直接对光反射迟钝甚至消失、眼压升高。1例患者在应用面罩接无创呼吸机第8天发生青光眼，通气模式BiPAP，IPAP10cmH2O，EPAP4cmHzO。另1例患者在应用气管插管接有创呼吸机第7天发生青光眼，通气模式A／C，FiO260％，PEEP5cmH20，Ps20cmHzO，f15bpm。2例均诊断为急性闭角型青光眼。给予降眼压治疗后，眼压降至正常范围，1例视力恢复，1例失明。结论机械通气可诱发青光眼，一旦发生，后果严重。对于应用机械通气的患者，医务人员需仔细观察患者的眼睛，一旦发现异常及时请眼科医师会诊，并且尽量避免应用抗胆碱药物、硝酸酯类药物、抗癫痫药、镇静催眠药、抗惊厥药、抗震颤麻痹药、抗精神病药、抗焦虑、抗躁狂及抗抑郁症药等诱发青光眼发作的药物。必要时可预防性应用降低眼内压的药物。
Objective To improve understanding of the glaucoma induced by positive pressure mechanical ventilation. Methods A retrospective analysis of two cases of glaucoma induced by positive pressure mechanical ventilation and literature review was conducted, Results One patient was a 77-year- old obese woman with a history of chronic obstructive pulmonary disease, hypertension and diabetes. The other was a 75-year-old thin man with interstitial pneumonitis, peptic ulcer. Both patients denied the history of glaucoma and other ocular diseases. The female patient was undergoing no-invasive positive pressure mechanical ventilation. The mode was BiPAP, IPAP 10 cm H20, EPAP 4 cm H20. She reported blind in the right eye 8 days after mechanical ventilation. The male patient was undergoing endotraeheal intubation and positive pressure mechanical ventilation. The mode was A/C, FiO2 60% PEEP 5 cm H20, Ps 20 cm H2O, f 15 bpm. He reported tears and pain in both eyes 7 days after mechanical ventilation. The two patients were diagnosed as acute glaucoma. After treatment one patient＇s eyesight recovered, but the other lost her sight. Conclusions The glaucoma could be induced by positive pressure mechanical ventilation. The medical stuff need pay more attention to the complication of mechanical ventilation.
出处
《国际呼吸杂志》
2013年第1期22-26,共5页
International Journal of Respiration
基金
北京积水潭医院千层次人才培养项目
关键词
青光眼
机械通气
Glaucoma
Mechanical ventilation
