视网膜静脉阻塞的病因和影响视力预后的相关因素分析

发布时间：2018-02-22 11:29

本文关键词： 视网膜静脉阻塞并发症视力预后低视力盲目　出处：《新疆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：研究各型视网膜静脉阻塞的病因和影响视力预后的因素。方法：视网膜静脉阻塞患者341例（345眼），年龄16-78岁，平均（53.5±12.6）岁。患者所有临床资料输入计算机，应用SPSS17.0软件进行统计学处理。结果：（1）导致静脉阻塞发生的全身危险因素：高血压患者203例（205眼），占59.5%，动脉粥样硬化患者217例（218眼），占63.6%，血液粘稠度增高患者86例（87眼），占25.2%，青光眼患者11例（12眼），占3.2%，糖尿病患者24例（24眼），占7.0%；不同类型静脉阻塞患者的全身危险因素不同。（2）导致静脉阻塞发生的局部危险因素：247例RVO患者阻塞眼眼压较对侧眼低0.8-5.9mmHg；阻塞眼眼压日变化差值平均为（4.55±1.47）mmHg，与对侧眼比较差异有统计学意义（P＜0.05）；337例RVO患者阻塞眼眼轴长度平均值为（22.37±0.51）mm，与对侧眼比较差异无统计学意义（P＞0.05）。（3）按阻塞部位分型：中央静脉阻塞150眼，占43.5%，分支静脉阻塞175眼，占50.7%，半侧静脉阻塞20眼，占5.8%。（4）按缺血与否分型：缺血型182眼，占52.8%；非缺血型163眼，占47.2%。（5）患者治疗有效率：中央静脉阻塞治疗有效率为51.3%，分支静脉的治疗有效率为66.3%，半侧静脉阻塞的治疗有效率为65.0%；缺血型的有效率为51.3%，非缺血型的有效率为66.3%；7天内就诊并得到及时有效处理的治疗有效率为77.2%，超过7天才就诊的有效率为29.4%。（6）患者初诊视力水平与预后：初诊视力水平均与视力预后密切相关（2值分别为68.370,39.684,11.753；P值分别＜0.001,＜0.001,＜0.05）。（7）静脉阻塞患者并发症的发生率：黄斑囊样水肿占46.4%，新生血管占21.6%，玻璃体出血占21.6%，新生血管性青光眼占4.3%。（7）静脉阻塞导致的低视力和盲目率：根据阻塞部位不同，各型静脉阻塞患者的低视力及盲目率比较，差异有显著意义（2值分别为7.478,21.420；P值分别＜0.05,＜0.001）；缺血型与非缺血型患者的低视力与盲目率比较，差异有统计学意义（2值分别为30.998,27.460；P值分别＜0.001,＜0.001）；且中央静脉阻塞与分支静脉阻塞的缺血型与非缺血型的低视力与盲目率比较，差异也有统计学意义（2值分别为12.341,24.919,13.753,5.190；P值分别＜0.001,＜0.001,＜0.001,＜0.05）。（8）发生并发症病例的低视力和盲目率：发生黄斑囊样水肿的患者中，，低视力者占33.1%，盲目者占12.5%，发生新生血管患者中，低视力者占9.6%，盲目者占13.7%。结论：视网膜静脉阻塞的致盲率较高，缺血型视网膜静脉阻塞对视力损害严重。与RVO发病有关的全身危险因素可能有高血压、动脉粥样硬化、血液粘稠度增高、糖尿病、青光眼；局部可能与眼压、眼压日变化差值、眼轴等有关。初诊视力水平与视力预后关系密切，黄斑囊样水肿、新生血管及新生血管性青光眼为致盲的重要原因。
[Abstract]:Objective: to study the etiology of various types of retinal vein occlusion (RVO) and the factors affecting the prognosis of visual acuity. Methods: 341 patients with retinal vein occlusion (RVO), aged 16-78 years (mean 53.5 卤12.6) years, were treated with computer. Results the systemic risk factors of venous obstruction were as follows: 203,205 eyes (59.5%) with hypertension, 217 cases (63.6 eyes) with atherosclerosis, 86 cases with high blood viscosity. 87 eyes (25.2%), 11 patients with glaucoma (12 eyes, 3.2 eyes), 24 patients with diabetes mellitus (24 eyes, 24 eyes), 7.0%; patients with different types of vein obstruction have different systemic risk factors. The mean diurnal difference of intraocular pressure was 4.55 卤1.47 mm Hg, which was significantly higher than that of contralateral eye (P < 0.05). The mean axial length of obstructive eye in 337 patients with RVO was 22.37 卤0.51mm, but had no significant difference from that of contralateral eye (P > 0.05). According to the location of occlusion, 150 eyes with central vein occlusion, There were 175 eyes with branch vein obstruction (50.7%), 20 eyes with hemilateral vein occlusion (5.80.45%) according to whether they were ischemic or not: 182 eyes with ischemic type (52.8%) and 163 eyes with non-ischemic type. The effective rate of treatment was 51.3 for central vein occlusion, 66.3 for branch vein, 65.0 for hemilateral vein occlusion, 51.3 for ischemic type and 66.3for non-ischemic type. The effective rate of seeing a doctor and receiving timely and effective treatment was 77.2, and the effective rate of more than 7 days was 29.4and 29.4and the prognosis of the patients was 29.40.The visual acuity level at first visit was closely related to the prognosis of visual acuity, and the two values were 68.370nil 39.684n11.753p < 0.001, < 0.001, < 0.05n.753 P respectively). Incidence of complications in patients with venous obstruction: macular cystic edema accounted for 46.4%, neovascularization 21.6%, vitreous hemorrhage 21.6%, neovascular glaucoma 4.3%) low vision and blind rate due to venous obstruction: depending on the location of obstruction, There were significant differences in the low visual acuity and blind rate between the patients with venous obstruction and the patients with blood type deficiency and non-ischemic type, the difference was 7.478t 21.420 (P < 0.05, < 0.001), and the low vision and blind rate of the patients with blood type deficiency and non-ischemic type were lower than that of the patients with non-ischemic type, and the difference was significant (P < 0.05, P < 0.001). The difference was statistically significant (P < 0.001, P < 0.001, P < 0.001 respectively), and the blood type deficiency and blind rate of central vein occlusion and branch vein occlusion were lower than those of non-ischemic type, and the difference was statistically significant (P < 0.001, P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). The difference was also statistically significant (P < 0.001, < 0.001, < 0.001, < 0.001, < 0.05, < 0.05) respectively. In the patients with macular sac edema, the low vision was 33.1and the blind was 12.55.190 P < 0.001, < 0.001, < 0.001, < 0.05, respectively: among the patients with macular sac edema, the low vision was 33.1and the blind was 12.55.In the patients with neovascularization, the visual acuity was 33.1, the blindness was 12.5. Conclusion: the blindness rate of retinal vein occlusion is high, the ischemic retinal vein occlusion has serious visual impairment. The systemic risk factors related to the pathogenesis of RVO may be hypertension, atherosclerosis. Increased blood viscosity, diabetes, glaucoma; local may be related to intraocular pressure, diurnal change of intraocular pressure, eye axis, etc. The level of primary visual acuity is closely related to the prognosis of visual acuity, macular cystic edema, Neovascularization and neovascular glaucoma are important causes of blindness.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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