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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2024, Vol. 10 ›› Issue (03) : 147 -150. doi: 10.3877/cma.j.issn.2095-9141.2024.03.004

临床研究

神经外科围术期瞳孔改变的相关因素分析
赵浩1, 尚峰1, 程玮涛1, 徐跃峤1, 齐猛1, 蒋丽丹1, 陈文劲1, 王宁1, 曲鑫1,†()   
  1. 1. 100053　北京，首都医科大学宣武医院神经外科
  • 收稿日期:2024-01-26 出版日期:2024-06-15
  • 通信作者: 曲鑫

Analysis of related factors of perioperative pupil change in neurosurgery

Hao Zhao1, Feng Shang1, Weitao Cheng1, Yueqiao Xu1, Meng Qi1, Lidan Jiang1, Wenjin Chen1, Ning Wang1, Xin Qu1,†()   

  1. 1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2024-01-26 Published:2024-06-15
  • Corresponding author: Xin Qu
  • Supported by:
    Capital Medical University Incubation Fund(PYZ21037)
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赵浩, 尚峰, 程玮涛, 徐跃峤, 齐猛, 蒋丽丹, 陈文劲, 王宁, 曲鑫. 神经外科围术期瞳孔改变的相关因素分析[J]. 中华神经创伤外科电子杂志, 2024, 10(03): 147-150.

Hao Zhao, Feng Shang, Weitao Cheng, Yueqiao Xu, Meng Qi, Lidan Jiang, Wenjin Chen, Ning Wang, Xin Qu. Analysis of related factors of perioperative pupil change in neurosurgery[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(03): 147-150.

目的

分析神经外科围术期患者瞳孔突然改变的相关因素，评估头颅CT复查的必要性。

方法

回顾性收集首都医科大学宣武医院神经外科自2020年12月至2024年1月收治的29例神经外科术后突发瞳孔改变的患者为瞳孔变化组，选取同期神经外科术后常规复查头颅CT且无瞳孔变化的29例患者为瞳孔无变化组。收集所有患者的临床资料，采用单因素和多因素Logistic回归分析筛选术后瞳孔变化的潜在影响因素。

结果

瞳孔变化组和瞳孔无变化组患者的一般资料比较差异无统计学意义（P>0.05）。单因素Logistic回归分析显示性别、气管插管镇静镇痛、使用异丙托溴铵雾化吸入、颅内病情变化与患者突发瞳孔改变无明显关系，意识变化和是否进行临床处理与患者突发瞳孔改变有关。多因素Logistic回归分析显示，患者意识改变和需要临床干预是围术期瞳孔改变的独立危险因素。

结论

神经外科围术期患者发生瞳孔改变后，伴随意识改变和采取临床干预是其危险因素，需要紧急复查头颅CT，为患者制定个性化治疗方案。

关键词: 瞳孔变化, 意识改变, 临床干预, 头颅CT, 神经外科围术期
Objective

To analyze the factors associated with sudden changes in pupil size in neurosurgical perioperative patients and evaluate the necessity of repeat head CT scans.

Methods

A retrospective collection was conducted of 29 cases of sudden postoperative pupil changes in neurosurgical patients treated at Neurosurgery Department of Xuanwu Hospital, Capital Medical University from December 2020 to January 2024. The control group consisted of 29 neurosurgical patients who underwent routine postoperative head CT scans during the same period without any changes in pupil size. Clinical data were collected, and both univariate and multivariate Logistic regression analyses were performed to identify potential influencing factors for postoperative pupil changes.

Results

There was no significant difference in general data between the group of patients with pupil changes and the group without pupil changes (P>0.05). Univariate Logistic analysis indicated no significant association between sudden pupil changes and factors such as gender, tracheal intubation with sedation and analgesia, the use of ipratropium bromide nebulization inhalation and intracranial disease changes, however, changes in consciousness and clinical intervention were significantly associated with sudden pupil changes. Multivariate Logistic analysis revealed that changes in consciousness and the need for clinical intervention were independent risk factors for detecting pupil changes.

Conclusion

Following perioperative pupil changes, accompanying changes in consciousness and the need for clinical intervention are significant risk factors. It is necessary to urgently review the head CT and develop personalized treatment plans for the patients.

Key words: Pupil change, Consciousness change, Clinical intervention, Head CT, Neurosurgery perioperative period
表1 2组患者的一般资料比较
Tab.1 Comparison of general information between two groups
项目 瞳孔变化组（n=29） 瞳孔无变化组（n=29） χ2/t值 P值
性别[例（%）]     1.732 0.188
男 13（44.8） 18（62.1）    
女 16（55.2） 11（37.9）    
年龄（岁，±s） 60.28±14.23 55.59±16.50 -1.159 0.251
气管插管镇静镇痛[例（%）] 12（41.4） 12（41.4） 0.000 1.000
使用异丙托溴铵雾化吸入[例（%）] 12（41.4） 12（41.4） 0.000 1.000
意识改变[例（%）] 6（20.7） 0（0） 6.692 0.010
颅内病情变化[例（%）] 2（6.9） 6（20.7） 2.320 0.128
需要临床干预[例（%）] 11（37.9） 2（6.9） 8.031 0.005
表2 导致瞳孔改变相关影响因素变量赋值表
Tab.2 Variable assignment table for factors related to pupil changes
变量 赋值
0 1
性别 女性 男性
气管插管镇静镇痛 否 是
意识改变 否 是
使用异丙托溴铵雾化吸入 否 是
是否需要临床干预 否 是
颅内病情变化 否 是
表3 瞳孔改变的单因素Logistic回归分析
Tab.3 Univariate factor Logistic regression analysis of pupil changes
项目 偏回归系数 标准误 Wald χ2值 P值 OR值 95%CI
性别（男性） -0.700 0.535 1.715 0.190 0.497 0.174~1.416
年龄 0.020 0.018 1.334 0.248 1.021 0.986~1.056
气管插管镇静镇痛 0.000 0.533 0.000 1.000 1.000 0.352~2.844
使用异丙托溴铵雾化吸入 0.000 0.533 0.000 1.000 1.000 0.352~2.844
意识改变 -2.435 0.872 6.712 0.039 0.214 0.034~0.783
颅内病情变化 -1.259 0.864 2.121 0.145 0.248 0.052~1.545
需要临床干预 -2.110 0.827 6.515 0.011 0.121 0.024~0.613
表4 瞳孔改变的多因素Logistic回归分析
Tab.4 Multivariate Logistic regression analysis of pupil changes
项目 偏回归系数 标准误 Wald χ2值 P值 OR值 95%CI
意识改变 -2.562 0.769 5.172 0.039 0.044 0.036~0.869
需要临床干预 -2.399 1.144 4.397 0.036 0.091 0.010~0.855
截距 1.705 0.769 4.918 0.027 5.500  
[1]
郭俊,王荣,闵飞华.外伤后急性弥漫性脑肿胀的危险因素的研究[J].中华实验外科杂志, 2023, 40(2): 377-379. DOI: 10.3760/cma.j.cn421213-20210908-00698.
[2]
郭晓明,李安民,张志文,等.双侧瞳孔散大的外伤性脑疝手术疗效分析[J].中华创伤杂志, 2006, 22(6): 431-433. DOI: 10.3760/j:issn:1001-8050.2006.06.010.
[3]
Gao G, Wu X, Feng J, et al. Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study[J]. Lancet Neurol, 2020, 19(8): 670-677. DOI: 10.1016/s1474-4422(20)30182-4.
[4]
Larsen RS, Waters J. Neuromodulatory correlates of pupil dilation[J]. Front Neural Circuits, 2018, 12: 21. DOI: 10.3389/fncir.2018.00021.
[5]
Viglione A, Mazziotti R, Pizzorusso T. From pupil to the brain: new insights for studying cortical plasticity through pupillometry[J]. Front Neural Circuits, 2023, 17: 1151847. DOI: 10.3389/fncir.2023.1151847.
[6]
Nieuwenhuis S, De Geus EJ, Aston-Jones G. The anatomical and functional relationship between the P3 and autonomic components of the orienting response[J]. Psychophysiology, 2011, 48(2): 162-175. DOI: 10.1111/j.1469-8986.2010.01057.x.
[7]
Kim JH, Yin C, Merriam EP, et al. Pupil size is sensitive to low-level stimulus features, independent of arousal-related modulation[J]. eNeuro, 2023, 10(10): ENEURO.0005-23.2023. DOI: 10.1523/eneuro.0005-23.2023.
[8]
Reimer J, Froudarakis E, Cadwell CR, et al. Pupil fluctuations track fast switching of cortical states during quiet wakefulness[J]. Neuron, 2014, 84(2): 355-362. DOI: 10.1016/j.neuron.2014.09.033.
[9]
Garcia Castro J, Díaz de Terán J. Reversible mydriasis of sudden onset: think before you act[J]. J Emerg Med, 2021, 61(4): e77-e79. DOI: 10.1016/j.jemermed.2021.05.012.
[10]
McAvoy M, Lee G, Boop S, et al. Fixed, dilated, and conversing-unreactive pupil with preserved consciousness indicating acutely rising intracranial pressure due to traumatic intraparenchymal contusions: case report and review of the literature[J]. Neurohospitalist, 2022, 12(2): 355-360. DOI: 10.1177/19418744211056613.
[11]
Shree R, Mahesh KV, Balaini N, et al. Oculomotor cranial neuropathies: diagnosis and management[J]. Ann Indian Acad Neurol, 2022, 25(Suppl 2): S70-S82. DOI: 10.4103/aian.aian_167_22.
[12]
Ong CJ. The prognostic potential of pupillometry in patients with acute brain injury[J]. Lancet Neurol, 2023, 22(10): 876-878. DOI: 10.1016/s1474-4422(23)00314-9.
[13]
Oddo M, Taccone FS, Petrosino M, et al. The neurological pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study[J]. Lancet Neurol, 2023, 22(10): 925-933. DOI: 10.1016/s1474-4422(23)00271-5.
[14]
Pennington KM, St Louis EK. "Don't believe your eyes" ipratropium induced mydriasis: a case report and review of the literature[J]. Gen Med (Los Angel), 2016, 4(3): 255. DOI: 10.4172/2327-5146.1000255.
[15]
Kokulu K, Öner H, Özen C, et al. Pharmacologic anisocoria due to nebulized ipratropium bromide: a diagnostic challenge[J]. Am J Emerg Med, 2019, 37(6): 1217.e3-1217.e4. DOI: 10.1016/j.ajem.2019.03.047.
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