205例“百万贫困白内障患者复明工程”术后效果分析

发布时间：2018-02-12 01:10

本文关键词： 百万贫困白内障患者复明工程术后效果并发症成本/效果　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过分析享受政府“百万贫困白内障患者复明工程”资助的贫困白内障患者手术效果及其相关影响因素,为提高适宜有效、方便可及、费用低廉、可持续的贫困白内障手术效率提供依据。方法:运用回顾性分析方法,采用内容包括:基本信息、术前视力、白内障类型、核硬度、相关全身疾病、眼部其他疾病、视力差(年)、术中并发症、手术方式、术后早期并发症、术后3d视力、费用等信息的白内障临床效果调查表,随机抽取2012年4月至2012年2月在山西省眼科医院受“百万贫困白内障复明工程”资助行白内障手术治疗的贫困组205例205眼、非贫困组226例226眼进行术后效果、成本/效果的比较分析。所收集数据经过复核无误后,采用多重回归模型进行术后视力影响因素分析。手术医师、护理标准无区别,所有信息采集及信息录入由同一位具有一定专业知识人员完成。结果:1.贫困组和非贫困组术前术后视力比较:⑴贫困组与非贫困组术前视力比较差异有统计学意义(P0.001),贫困组术前视力平均值低于非贫困组;⑵贫困组与非贫困组术后3d视力比较差异有统计学意义(P0.001),且两组较术前视力提高程度之间差异有统计学意义(P0.001),非贫困组较贫困组视力提高更为明显,手术效果好;⑶贫困组与非贫困组术前视力与术后3d视力比较差异均具有统计学意义(P0.001),两组患者手术后视力均明显提高;⑷贫困组术后脱盲率为94.1%,脱残率为76.6%;非贫困组术后脱盲率为98.7%,脱残率为89.4%,达到国家扶贫白内障手术相关标准要求。2.贫困组与非贫困组术中术后并发症比较:⑴贫困组术中并发症有后囊膜破裂、玻璃体丢失、晶状体核沉入玻璃体1例及悬韧带断裂1例,非贫困组未见术中并发症发生,两组术中并发症发生率无明显差异(P0.05);⑵贫困组术后38例有角膜水肿、2例有高眼压表现,非贫困组术后角膜水肿9例、黄斑水肿2例,两组术后并发症发生率差异具有统计学意义(P0.001),贫困组术后早期并发症发生率高于非贫困组。3.贫困组与非贫困组术后视力影响因素分析:⑴贫困组术后3d视力影响因素有视力差(年)、白内障分类、核硬度及眼部其他疾病(P0.05),而年龄、性别对术后视力无明显影响(P0.05);⑵非贫困组术后3d视力主要影响因素有白内障分类及眼部其他疾病(P0.05),年龄、性别及核硬度对术后视力无明显影响;⑶综合组术后3d视力影响因素主要有白内障分类、核硬度及眼部其他疾病(P0.05),年龄、性别对术后视力无明显影响。4.贫困组与非贫困组多重回归模型对术后视力影响因素进行分析:⑴眼部其他疾病、核硬度是贫困组术后视力的影响因素,回归方程为Y=3.817-0.384X1+0.159 X2;⑵眼部其他疾病是非贫困组术后视力的影响因素,回归方程为Y=2.793+0.15 X。5.贫困组手术成本及成本/效果分析:⑴贫困组患者总费用为(2098.707±353.478)元,非贫困组(5077.190±1753.448)元,差异具有统计学意义(P0.001);⑵贫困组治愈的成本/效果为3284.362元,低于非贫困组治愈成本/效果6154.170元;⑶贫困组白内障患者手术脱盲的成本/效果为2220.854元,低于非贫困组白内障患者手术成本/效果5144.063元;⑷贫困组白内障患者手术脱残的成本/效果为2739.826元,低于非贫困白内障患者脱残手术成本/效果5679.183元。结论:1.白内障分类、眼部其他疾病、核硬度是贫困组影响术后视力的主要因素;2.贫困组手术费用低于非贫困组,且贫困组手术成本/效果较非贫困组低。3.贫困组术后视力较术前视力明显提高,效果确切。脱盲率为94.1%,脱残率为76.6%,达到国家相关对贫困患者复明手术的相关要求,“百万贫困白内障患者复明工程”是费用低廉、效果确切的白内障扶贫复明策略之一。
[Abstract]:Objective: to analyze the factors of poor cataract patients enjoy the operation effect of the government "millions of poor cataract patients and its related project, in order to improve the appropriate and effective, convenient and low cost, provide the basis for cataract surgery in poor efficiency and sustainable. Methods: using a retrospective analysis method, the contents include: basic information, preoperative visual acuity, type of cataract, nuclear hardness, systemic disease and other diseases of the eye, poor eyesight (years), intraoperative complications, surgical methods, postoperative complications, postoperative visual acuity was 3D, the clinical effect of cataract cost information, randomly selected from April 2012 to February 2012 by the millions of poor cataract treatment project the poor cataract surgery group 205 cases 205 eyes in Eye Hospital of Shanxi Province, the non poverty group 226 cases 226 eyes underwent the effect, comparative analysis of cost / effect. The data collected through review and correct analysis, using multiple regression model for postoperative visual acuity factors. The surgeon, the standard of care without distinction, all the information collection and information input by the same one has completed certain professional knowledge workers. Results: 1. compared with the poor group and the non poor eyesight group before and after surgery are: 1 the statistical significance of the poor group and the non poor preoperative visual acuity difference (P0.001), poverty group preoperative visual acuity less than the average non poverty group; the poverty group was statistically significant and non poor postoperative visual acuity difference 3D (P0.001), and the difference was statistically significant between the two groups was better than preoperative vision degree (P0.001), non impoverished group than in poor eyesight improved more obviously, the operation effect is good; the poverty group and non poverty group preoperative visual acuity and postoperative visual acuity of 3D were statistically significant (P0.001), visual acuity of two groups of patients after surgery Increased; the poverty group after the literacy rate is 94.1%, and the residual rate was 76.6%; the non poverty group after the literacy rate is 98.7%, and the residual rate was 89.4%, reached the standard of national poverty related cataract surgery.2. poverty group and non poverty group complications in comparison: the complication group was poor a posterior capsular rupture, vitreous body loss, 1 cases of lens nucleus into vitreous body and suspensory ligament rupture in 1 cases, non impoverished group had no complications during operation, complications of the two groups were no significant difference in the incidence of poverty (P0.05); the group of 38 patients with corneal edema, 2 cases with high intraocular pressure, the non poverty group the postoperative corneal edema in 9 cases, 2 cases of macular edema, postoperative complications of the two groups was statistically significant difference in the incidence of poverty group (P0.001), early postoperative complication rate was higher than that of non impoverished group.3. poverty group and non poverty factors influencing the eyesight after the operation of group analysis: the poverty group The influence factors of the 3D visual acuity after poor eyesight (years), nuclear cataract classification, hardness and other ocular diseases (P0.05), and age, gender has no significant effect on postoperative visual acuity (P0.05); the main influence factors of 3D non vision poverty group after cataract and other ocular disease classification (P0.05), age gender, and nuclear hardness had no obvious effect on postoperative visual acuity; the factors of 3D visual effect of comprehensive group are mainly Cataract Classification, nuclear hardness and other ocular diseases (P0.05), age, sex on the postoperative visual acuity had no significant effect on the.4. group and the non poverty poverty group multiple regression model of factors affecting postoperative visual acuity analysis: the other eye disease, nuclear hardness is visual impact factors of poverty group, the regression equation was Y=3.817-0.384X1+0.159 X2; the other is the eye disease factors influence non poor eyesight after the operation of group, the regression equation was Y=2.793+0.15 X.5. poverty groups Analysis of the effect of operation cost and total cost: 1 / poor patients was (2098.707 + 353.478), non poverty group (5077.190 + 1753.448), the difference was statistically significant (P0.001); the effect of poor cure cost is 3284.362 yuan, lower than the non poor groups into the cure effect of 6154.170 yuan /; the effect of the poor group of patients with cataract surgery have the cost of 2220.854 yuan, lower than the non poor groups of patients with cataract surgery cost / effect 5144.063 yuan; the poor group of patients undergoing cataract removal of residual cost is 2739.826 yuan, lower than the non poor cataract patients for removing residual operation cost / effect 5679.183 yuan. Conclusion: 1. Cataract Classification and other diseases of the eye, nuclear hardness is the poor group main factors affecting postoperative visual acuity; 2. poor group operation cost is lower than the non poor group and poor group operation cost / effect than the non impoverished group low.3. poverty group after operation visual acuity The visual acuity was improved, the effect is obvious. The literacy rate is 94.1%, and the residual rate was 76.6%, to meet the relevant requirements of the relevant national poverty patients with cataract surgery, "millions of poor cataract patients is one of the engineering cost is low, the exact effect of cataract cataract poverty alleviation strategy.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.66

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