慢性肾衰竭患者血液透析前后眼压与前房相关参数的关系研究

发布时间：2018-04-15 07:26

本文选题：血液透析 + 眼压　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:研究慢性肾衰竭患者血液透析前后眼压的变化与前房相关参数的关系,并探讨眼压变化的相关机制。方法:选取2015年1月至12月在我院肾内科接受血液透析治疗的慢性肾衰竭患者52例52眼(均取右眼为观察眼),根据Shaffer分级法并结合超声生物显微镜将52只眼分为四组:宽房角组、窄房角组、极窄房角组及闭角组。分别在血液透析前和透析结束后60sec内采取患者静脉血以计算血浆渗透压。采用手持回弹式眼压计分别在血液透析开始前30min内、透析2h后和透析结束后30min内测量眼压。在血液透析前和透析后30min内,分别采用角膜内皮细胞计数仪、眼部A超和超声生物显微镜进行中央角膜厚度、中央前房深度、晶状体厚度、房角开放距离、小梁虹膜角、虹膜根部厚度和睫状体厚度的测定。结果:血液透析后血浆渗透压显著降低,差异有统计学意义(t=3.04,P0.05)。血液透析不同时间点患者眼压的均数不全相同(F=41.69,P0.01),即眼压的变化具有时间差异性,其中透析前眼压与透析2h眼压相比差异有统计学意义(P0.01),透析后眼压与透析2h眼压相比差异有统计学意义(P0.01)。血液透析不同分组患者眼压的均数不全相同(F=6.44,P0.01),即眼压的变化具有组间差异性,其中宽房角组眼压与极窄房角组眼压相比差异有统计学意义(P0.05),窄房角组眼压和极窄房角组眼压相比差异有统计学意义(P0.01)。此外,极窄房角组患者眼压在透析2h较透析前明显升高,差异有统计学意义(P0.05)。透析后眼压又恢复至透析前的水平。血液透析后各组睫状体厚度均变薄,只有宽房角组与透析前相比差异有统计学意义(t=2.61,P0.05)。血液透析后中央角膜厚度、中央前房深度、房角开角距离、小梁虹膜角和虹膜根部厚度均降低,而晶状体厚度增加,但这些改变均没有统计学意义。结论:血液透析对患者眼压的影响与前房角的功能状态相关,其中极窄房角结构是血液透析过程中眼压升高的危险因素,窄房角结构可能是危险因素,宽房角结构的患者则相对安全。应及早对血液透析患者进行眼部筛查,并关注窄房角解剖结构的患者。
[Abstract]:Aim: to study the relationship between intraocular pressure (IOP) and anterior chamber parameters in patients with chronic renal failure (CRF) before and after hemodialysis, and to explore the mechanism of IOP changes.Methods: 52 cases (52 eyes) of chronic renal failure treated by hemodialysis in our hospital from January to December 2015 were selected. 52 eyes were divided into two groups according to Shaffer classification and ultrasound biomicroscopy.Four groups: wide chamber angle group,Narrow angle group, very narrow angle group and closed angle group.Venous blood was taken to calculate plasma osmotic pressure in 60sec before and after hemodialysis, respectively.Intraocular pressure (IOP) was measured by handheld rebound intraocular pressure (IOP) in 30min before hemodialysis, 2 hours after dialysis and after dialysis.The central corneal thickness, central anterior chamber depth, lens thickness, angle open distance, trabecular iris angle and trabecular iris angle were measured before and after hemodialysis in 30min by corneal endothelial cell counter, eye A ultrasound and ultrasound biomicroscopy.Measurement of iris root thickness and ciliary body thickness.Results: the plasma osmotic pressure decreased significantly after hemodialysis, and the difference was statistically significant.The mean values of IOP in patients with hemodialysis at different time points were not all the same.There was significant difference between pre-dialysis IOP and 2h intraocular pressure (P 0.01), and there was significant difference in intraocular pressure (IOP) between 2 h after dialysis and 2 h after dialysis (P 0.01).The mean of intraocular pressure in different groups of hemodialysis patients was not the same as that in different groups of hemodialysis patients (P 0.01), that is, the change of intraocular pressure was different among groups.There was significant difference in intraocular pressure between wide angle group and very narrow angle group (P 0.05), and there was significant difference between narrow angle group and very narrow angle group (P 0.01).In addition, the IOP in the very narrow angle group was significantly higher than that before dialysis for 2 hours, and the difference was statistically significant (P 0.05).After dialysis, intraocular pressure returned to the level before dialysis.After hemodialysis, the thickness of ciliary body in each group was thinned, but there was significant difference between the wide angle group and pre-dialysis group.After hemodialysis, the central corneal thickness, the depth of the anterior chamber, the distance between the angle opening, the trabecular iris angle and the thickness of the iris root decreased, but the lens thickness increased, but these changes were not statistically significant.Conclusion: the effect of hemodialysis on intraocular pressure is related to the functional state of anterior chamber angle. The structure of extremely narrow atrial angle is a risk factor for the elevation of intraocular pressure during hemodialysis, and narrow angle structure may be a risk factor.Patients with wide angle structures are relatively safe.Eye screening should be carried out early for hemodialysis patients and attention should be paid to patients with anatomic structure of narrow atrium angle.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R771.3

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