绷带镜对糖尿病患者玻璃体切割术后角膜上皮愈合影响的临床研究

发布时间：2018-03-18 00:38

本文选题：绷带镜　切入点：糖尿病　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:观察糖尿病性视网膜病变患者玻璃体切割术后对角膜上皮的影响,探讨角膜绷带镜对此类患者角膜上皮修复的作用。方法:选取2014年1月到2016年1月因糖尿病性视网膜病变在我院接受玻璃体切除术患者作为研究对象。入选前排除患有严重干眼、睑缘炎等可能影响术后角膜上皮修复的疾病,将患者随机分为观察组和对照组。对照组患者术后接受常规药物治疗,观察组患者在常规药物治疗的基础上联合使用绷带镜进行治疗,分别在术后1天,1周,2周,3周,1月进行随访。观察并比较两组患者治疗后的角膜上皮愈合情况,眼部症状、疼痛情况、视力,眼压等,并对研究结果进行分析,采用SPSS 22.0进行统计分析。结果:随访期间共有符合条件患者46例(46眼),其中观察组和对照组各23例(23眼)。术前观察组BUT平均值为7.81±3.21s,对照组为8.01±2.10s,两组间差别没有统计学意义(t=0.234,P=0.612);观察组泪液分泌试验平均值为10.73±6.12mm,对照组11.02±5.62mm,两组间差别无明显统计学差异(t=0.306,P=0.412)。对照组患者角膜上皮愈合时间5天到62天,平均21.6±11.2天,持续性角膜上皮缺损11例,观察组角膜上皮愈合时间3天到42天,平均13.3±8.4天,其中持续性角膜上皮缺损超过2周患者5例。两组间差别有统计学意义(t=2.631,p=0.003)。两组患者在接受治疗后,第一周愈合例数(观察组11例,占47.8%,对照组4例,占17.3%),第二周(观察组18例,占比例78.3%,对照组为12例,占52.1%),观察组角膜上皮愈合时间大大缩短,其中观察组1例患者因绷带镜贴合不紧密致上皮愈合时间超过6周。两组患者眼部舒适度比较,第一周患者眼部异物感观察组0.34±0.27分,对照组0.53±0.22分(χ2=2.6163,P=0.0121);眼部刺痛观察组0.69±0.25分,对照组0.96±0.21分(χ2=3.96,P=0.0003);畏光流泪观察组 0.41±0.39 分,对照组 0.65±0.33(χ2=2.253,P=0.0293),观察组明显优于对照组患者。随着两组角膜上皮的逐渐愈合,其舒适度在后期逐渐接近,但前3周内其评分仍存在统计学差异。眼部疼痛方面比较,第一周观察组0.5级有22例(95.65%),1级仅为1例,没有2级疼痛患者;对照组0.5级有16例(69.57%),1级6例(26.09%),2级疼痛1例(4.35%),观察组在0.5级及1级疼痛上明显优于对照组(0.5级χ2=4.072,P=0.044;1级χ2=16.133,P=0.000)。结论:角膜上皮持续不愈合是糖尿病性视网膜病变患者术后常见的眼表并发症,角膜绷带镜能显著促进糖尿病性视网膜病变患者玻璃体切除术后角膜上皮的愈合,对减轻患者眼部症状和提高生活质量具有很重要的作用。
[Abstract]:Objective: to observe the effect of vitrectomy on corneal epithelium in patients with diabetic retinopathy. Objective: to investigate the effect of corneal bandage on corneal epithelium repair in patients with diabetic retinopathy from January 2014 to January 2016. The patients undergoing vitrectomy in our hospital from January 2014 to January 2016 were selected as subjects. With the exception of severe dry eyes, The patients were randomly divided into observation group and control group. The patients in the control group received routine drug treatment after operation. The patients in the observation group were treated with bandage lens on the basis of routine drug therapy. The patients in the observation group were followed up on 1 day, 1 week, 2 weeks and 3 weeks, January, respectively. The healing of corneal epithelium and ocular symptoms were observed and compared between the two groups. Pain, visual acuity, intraocular pressure, etc., and analysis of the results of the study, SPSS 22.0 was used for statistical analysis. Results: during the follow-up period, 46 eyes of 46 eligible patients were diagnosed, 23 eyes of the observation group and 23 cases of the control group, the mean BUT of the preoperative observation group was 7.81 卤3.21 seconds, the control group was 8.01 卤2.10 s, the difference between the two groups was not uniform. The mean value of tear secretion test was 10.73 卤6.12mm in the observation group and 11.02 卤5.62mm in the control group. There was no significant difference between the two groups. The healing time of corneal epithelium in the control group was 5 days to 62 days. Mean 21.6 卤11.2 days and persistent corneal epithelial defects in 11 cases. The healing time of corneal epithelium in the observation group ranged from 3 days to 42 days, with an average of 13.3 卤8.4 days. There were 5 patients with persistent corneal epithelial defect for more than 2 weeks. The difference between the two groups was statistically significant. The patients in the two groups healed in the first week after treatment (11 cases in the observation group, 47.8 cases in the control group, 4 cases in the control group, 17.3%), the second week (18 cases in the observation group, 18 cases in the observation group, 18 cases in the observation group). There were 12 cases in the control group, accounting for 52.1%. The healing time of corneal epithelium in the observation group was greatly shortened, and the healing time of the epithelial epithelium in the observation group was more than 6 weeks due to the lack of bandage. The eye comfort of the two groups was compared. In the first week, the ocular foreign body sensation in the observation group was 0.34 卤0.27, in the control group 0.53 卤0.22 (蠂 ~ 2 / 2, 2.6163), in the eye tingling group was 0.69 卤0.25, and in the control group was 0.96 卤0.21 (蠂 ~ 2, 3.96, P ~ (0.0003); 0.41 卤0.39 in photophobia observation group, respectively). The control group was 0.65 卤0.33 (蠂 ~ 2 + 2.253), the observation group was obviously superior to the control group. With the gradual healing of corneal epithelium between the two groups, the degree of comfort gradually approached at the later stage, but there was still a statistical difference in the score within the first 3 weeks. In the first week, 22 cases of grade 0.5 were in the observation group, only 1 case was in grade 1, and there was no pain in grade 2. In the control group, there were 16 cases of grade 1 (69.57) and 6 cases of grade 1 (26.0909) with pain of grade 2 (4.35). The pain in the observation group was significantly better than that in the control group in grade 0.5 and grade 1 (蠂 24.072P 0.044 P 0.044) P 0.000.Conclusion: the persistent nonunion of corneal epithelium is common in the patients with diabetic retinopathy after operation. Eye surface complications, Corneal bandage can significantly promote the healing of corneal epithelium after vitrectomy in patients with diabetic retinopathy. It plays an important role in alleviating the ocular symptoms and improving the quality of life of patients with diabetic retinopathy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R779.6;R587.2

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