2.3  手术因素
　
　　2.3.1  CO2气腹：临床观察到腹腔镜手术患者气腹后10 min，PaCO2和IOP比气腹前分别上升26.93%、34.50%，放气后10 min仍比基础值升高，且PaCO2进一步升高。其原因是：CO2气腹造成腹内压升高，腹膜对CO2吸收，膈肌上升，潮气量下降，导致CVP上升，高CO2血症，PaCO2升高。提示：气腹后IOP随PaCO2上升，术毕放气后，IOP与PaCO2仍处于较高水平，其中眼压比气腹后10 min稍有下降，这可能与放气后胸腹压力、CVP降低有关[19]。其机制：PaCO2与静脉压升高时，使脉络膜血管扩张，毛细血管压力增加，导致房水生成增多，IOP升高。围手术期监测SPO2、PaCO2变化，必要时血气分析，控制高CO2血症发展，使IOP保持在正常范围。有青光眼、视网膜剥脱或有眼外伤患者应慎用腹腔镜手术。

　　2.3.2  体位（俯卧位）：有学者[20]选择俯卧位下行脊柱手术的病人进行研究，发现俯卧位明显增加麻醉状态病人的IOP。于俯卧位8 min后开始，IOP与仰卧位相比明显升高。同时还关注了手术时间长短的影响，发现：俯卧位时间长短与IOP的幅度成线形相关。眼灌注压=MAP-IOP，因此IOP的变化可能会影响视神经的灌注，同时MAP下降对眼有害。

　　3  结语

　　本文旨在总结围术期各种因素对眼部生理的影响，以从麻醉的角度采取相应的降眼压改善眼血液循环措施，避免对患者造成医源性眼损害。

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