전신 마취하 복강경 수술 시 복강 내압과 체위 변동이 안압에 미치는 영향
The Effect of Positional Change During Laparoscopic Surgery on Intraocular Pressure
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목적: 복강경 수술 시, 복압의 상승에 의한 안압 상승 및 체위 변동에 따른 안압 변화를 알아보고자 하였다. 대상과 방법: 복강경하 충수돌기절제술을 시행한 28명과 복강경하 담낭절제술을 시행한 20명, 2군을 대상으로 수술 전, 전신 마취후, 기복 형성 후, 술식에 따른 체위 변환 후, 기복 제거 후 전신 마취 상태에서 안압을 측정하였다. 결과: 기복 형성 전과 비교하여 기복형성 후 안압은 충수돌기절제술군에서 3.70 ± 0.96 mmHg, 담낭절제술군에서 3.15 ± 0.5 mmHg 상승하였다. 충수돌기절제술군에서 두위하방 상태에서의 안압은 체위변환 전 안압보다 3.25 ± 0.16 mmHg 상승하였고, 담낭절제술군에서 두위 상방 상태에서의 안압은 체위변환 전 안압보다 2 ± 0.12 mmHg 감소하였다. 두 군 간, 두위에 따른 체위 변환으로 6.5mmHg의 유의한 안압 차이가 있었다. 결론: 복강경술 시에 기복 형성은 안압 상승을 일으키며, 술식에 따른 체위 변동은 안압 변화를 일으켰고, 두 군 간에 안압의 차이가있었다. 복강경 수술로 인해 장시간 안압 상승에 노출되는 것을 줄이기 위해서는 기복형성 및 두위 하강 체위 유지 시간을 짧게 하는것이 도움이 되겠다.
Abstract
Purpose: The present study proposes to examine the change of IOP in response to the rise of abdominal pressure and in response to position change during laparoscopic surgery. Methods: The subjects of the present study included 28 patients who had laparoscopic appendectomy and 20 patients who had laparoscopic cholecystectomy. In both groups, the IOP was measured before surgery, after general anesthesia,after the occurrence of pneumoperitoneum, after position change according to operative method, after the removal of pneumoperitoneum and under general anesthesia. Results: When comparing the IOP before and after the occurrence of pneumoperitoneum, the IOP after the occurrence increased by 3.70 ± 0.96 mm Hg in the appendectomy group and by 3.15 ± 0.5 mm Hg in the cholecystectomy group. After the occurrence of pneumoperitoneum, the IOP measured in the head-low position was 3.25 ± 0.16 mm Hg higher than measured in the level position in the appendectomy group, and the IOP measured in the head-high position was 2 ± 0.12mm Hg lower than measured in the level position in the cholecystectomy group. Between the 2 groups, there was a significant difference of 6.5 mm Hg in IOP according to the change of head position. Conclusions: In the present study, the occurrence of pneumoperitoneum in laparoscopic surgery increased IOP, and position change according to operative method also changed IOP. In addition, IOP was significantly different between the 2groups. In order to prevent the patient from being exposed to high IOP for a long period during laparoscopic surgery, keeping the duration of pneumoperitoneum and a head-low position to a minimum may be helpful.
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