目的：探讨全身麻醉诱导期应用不同种类的非去极化肌松药罗库溴铵、顺式阿曲库铵和米库氯铵对眼压升高的青光眼患者眼内压的影响。方法：将术侧眼眼压>21mmHg青光眼手术患者随机分配到罗库溴铵组、顺式阿曲库铵组和米库氯铵组。靶控输注丙泊酚至患者脑电双频指数(bispectral index，BIS)低于55后，根据组别分别静注0.6mg/kg罗库溴铵、0.1mg/kg顺式阿曲库铵及0.2mg/kg米库氯铵，待4个成串刺激(train of four stimulation，TOF)比值降至0后置入可弯曲喉罩，随后行机械通气并给予芬太尼1.5~2.0μg/kg，2%~3%七氟烷吸入维持麻醉。分别于麻醉诱导前(T0)、镇静后(T1)、肌松后(T2)及喉罩置入后(T3)测量三组青光眼患者术侧眼眼压并记录上述时间点血流动力学参数。结果：罗库溴铵组、顺式阿曲库铵组、米库氯铵组患者的眼压在T1、T2、T3时间点均较T0显著下降，差异有统计学意义(均P<0.001)；三组患者T2时间点眼压与T1相比差异均无统计学意义(P=0.337，P=0.520，P=0.062)；三组患者给予肌松药前后的眼压差值(T2–T1)分别为(0.68±4.39)、(0.36±3.72)和(1.27±3.91)mmHg，组间比较差异无统计学意义(P=0.353)。结论：非去极化肌松药罗库溴铵、顺式阿曲库铵及米库氯铵对眼压升高的青光眼患者的眼压无明显影响，且3种肌松药之间未见显著差异。
Objective: To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia. Methods: Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group, cis-atracurium group and mivacurium group. After target controlled infusion of propofol until the bispectral index (BIS) lower than 55, 0.6 mg/kg rocuronium, 0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups. The flexible laryngeal mask was placed after the train-of-four stimulation (TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately. General anesthesia was maintained by 1.5–2.0 μg/kg fentanyl and 2%– 3% sevoflurane. Intraocular pressure and hemodynamic parameters were measured before anesthesia induction (T0), after sedation (T1), after muscle relaxation (T2), and after laryngeal mask insertion (T3). Results: The intraocular pressure of patients in rocuronium group, cis-atracurium group and mivacurium group at T1, T2, T3 were lower than baseline (T0), and the difference was statistically significant (P<0.001); There was no significant difference in intraocular pressure at T2 compared with T1 in rocuronium group, cis-atracurium group and mivacurium group (P=0.337, P=0.520 and P=0.062 respectively); The difference of intraocular pressure between T2 and T1 in rocuronium group, cis-atracurium group and mivacurium group were (0.68±4.39), (0.36±3.72) and (1.27±3.91) mmHg respectively and there was no significant difference among the groups (P=0.353). Conclusion: The non-depolarizing muscle relaxants rocuronium, cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure, and there is no significant difference among the three muscle relaxants.
晶状体诱导性青光眼(lens-induced glaucoma，LIG)是因晶状体蛋白相关或解剖学异常引起的一类继发性青光眼。基于发病机制，分为晶状体溶解性青光眼、晶状体颗粒性青光眼、晶状体过敏性青光眼、晶体膨胀性青光眼、瞳孔阻滞性青光眼等几类，房角可能是开放或关闭的。高分子量晶状体蛋白、晶状体颗粒释放、瞳孔阻滞、晶体体积增大是引起青光眼的机制。其病因包括膨胀期、成熟期或过熟期白内障，眼部手术和外伤，各种晶体脱位等。流行病学在发达国家和发展中国家各不相同。以视力下降、眼红、单侧眼痛等为主要临床表现，可产生青光眼性不可逆视功能损害。眼部超声检查对其诊断有帮助。需要和急性闭角型青光眼、睫状环阻滞性青光眼、脉络膜上腔出血、外伤或术后眼内炎等疾病相鉴别。治疗方法是去除晶体刺激物质，从而控制眼压。
Lens-induced glaucoma (LIG) is a kind of secondary glaucoma caused by lens proteins or anatomic abnormality of the lens. Based on the pathogenesis, LIG is classified as phacolytic glaucoma, lens-particle induced glaucoma, phacoanaphylactic glaucoma, phacomorphic glaucoma, pupillary block glaucoma. The angle may be open or closed. High-molecular-weight lens protein, release of lens particles, and pupillary block, increase in the volume of the cataractous lens are the mechanisms of glaucoma. Its pathogensis includes intumescent cataracts, mature senile cataract, hyper-mature senile cataracts, surgery and trauma in eyes, and dislocation of lens. The epidemiology varies across developed and developing countries. The common symptom includes diminution of vision, redness of the eye, and unilateral eye pain. It can cause glaucomatous irreversible visual impairment. Ocular ultrasonography is helpful for its diagnosis. Differential diagnosis includes acute angle-closure glaucoma, ciliary block glaucoma, supra-choroidal hemorrhage, post-traumatic or postoperative endophthalmitis. The management is the removal of inciting lenticular matter to control intraocular pressure
剥脱性青光眼是剥脱综合征继发的一类青光眼，临床上少见。本文报告2例患者，患眼瞳孔缘可见灰白色碎屑样物质沉积，散大瞳孔后可见晶状体前囊周边部混浊带，房角镜下可见Sampaolesi线。认识其临床特征，将有助于提高其诊治率。
Exfoliation glaucoma is a category of glaucoma secondary to exfoliation syndrome, which is rarely encountered in clinical practice. We reported 2 cases with deposits of white material on the pupillary border of the iris. Opacity band could be observed surrounding the anterior lens capsule after pupil dilation, and the Sampaolesi line was seen under gonioscope. Understanding the clinical characteristics contribute to improving the diagnosis and treatment of exfoliation glaucoma.
