全身病与玻璃体手术治疗的相互影响和处理措施的临床研究

发布时间：2018-11-14 15:23

【摘要】：目的通过观察权身病与玻璃体手术治疗的相互影响和处理措施,加强对全身病与玻璃体手术治疗相互影响的认识,积极采取合理的处理措施,提高手术安全性,改善治疗效果。方法对94例(103眼)合并全身病的玻璃体视网膜病变患者进行临床研究,其中男45例(48眼),女49例(55眼)。术前详细检查患者全身情况,监测并稳定血糖、血压等全身情况,观察患者能否耐受玻璃体手术。对患者进行详细的术前谈话,告知手术和全身病风险。所有玻璃体手术均在局麻下进行,术中根据具体情况联合品状体切除、视网膜前膜剥除、视网膜激光光凝、电凝、冷凝、眼内填充等；需行硅油取出术的患者也在局麻下手术,可根据情况联合人工晶状体植入等。术中均应用心电监护仪监测患者全身情况。术前术后对患者眼部部情况进行仔细的检查,观察并记录患者手术前后视力情况,统计术中、术后全身病变化及处理措施。术后随访2月-1年,观察随访时患者眼部及全身疾病情况。所有数据采用SPSS17.0软件系统进行分析。结果同期行玻璃体手术治疗的玻璃体视网膜病变患者』共523例,其中合并全身病的89例,占17.0%。 94例合并全身病的玻璃体视网膜病变患者中,89例(94.7%)顺利完成玻璃体手术治疗,5例(5.3%)因患者全身情况不能耐受手术,未予手术治疗。 89例(98眼)行玻璃体手术治疗的合并全身病的玻璃体视网膜病变患者中,3眼(3.1%)选择填充重硅油。41例(46.1%)术后全身应用皮质类固醇激索,48例(53.9%)因糖尿病等全身病原因术后未全身应用皮质类固醇激素；6例(6.7%)因糖尿病肾病围手术期选择应用肾毒性小的抗生素。6眼(6.1%)硅油填充术后并发轻度真菌性角膜溃疡。行玻璃体手术治疗的玻璃体视网膜病变患者中,合并全身病患者的年龄较未合并全身病患者大(P=0.000)。合并全身病患者(除外伤)的住院天数较未合并全身病患者(除外伤)长(P=0.044)。经玻璃体手术治疗,合并全身病的玻璃体视网膜病变患者的术后视力提高的有62眼(63.2%),视力不变的有23眼(23.5%),视力下降的有13眼(13.3%)。术中4例(4.5%)心率加快,3例(3.4%)心率减缓,6例(6.7%)血压升高。术后5例(5.6%)血压升高,7例(7.9%)血糖升高,2例(2.2%)肾病加重。结论 1、合并全身病患者在眼病患者中所占比例高,应用玻璃体手术治疗的比例亦高；部分全身病患者不能耐受或沟通后拒绝玻璃体手术治疗；部分患者术中引起心率、血压爪波动,手术应激和围手术期用药引起血糖、血压波动、肾病加重等；全身真菌性疾病可增加眼部发生真菌感染的机率。 2、提高对全身病与玻璃体手术治疗相互影响的认识；术前全面评估全身病患者全身情况,调整全身病至稳定状态,允分沟通告知全身病与手术风险：术中监测全身情况并及时调整,选择合适的眼内填充物；围手术期慎重选择全身药物；加强术后和出院指导。通过以上综合措施,可提高手术安全性,改善治疗效果。
[Abstract]:Purpose By observing the mutual influence and treatment measures of the right body disease and the vitreous surgery treatment, the mutual influence of the whole body disease and the vitreous surgery treatment is enhanced, reasonable treatment measures are taken, the operation safety is improved, and the treatment is improved. effect Methods 94 patients with vitreoretinopathy (103 eyes) with whole body disease were studied with clinical study, of which 45 (48 eyes), female, 49 cases (55 eyes). The whole body condition of the patient was examined in detail before the operation, and the whole body conditions such as blood sugar and blood pressure were monitored and stabilized. The patient was able to withstand the vitreous surgery. A detailed pre-operative conversation was performed on the patient, inform the operation and the whole body disease risk. All the vitreous surgery is performed under the local anesthesia, the operation is combined with the article-like body resection according to the specific conditions, the pre-retinal membrane stripping, the retinal laser photocoagulation, the electrocoagulation, the condensation, the in-eye filling and the like; and the silicon is required to be carried out. The patient who has been removed from the oil is also operated under the local anesthesia and may The combination of intraocular lens implantation and the like according to the condition. The general condition of the patient was monitored by an ECG monitor. The patient's eyes were examined carefully before and after the operation, and the vision and statistics before and after the operation of the patient were observed and recorded. The changes of the whole body's disease and its treatment after operation. Follow-up for 2 months to 1 year after operation. Patient's eye and body condition at follow-up. All data is SP SS A total of 523 patients with vitreoretinopathy treated with vitreoretinal surgery in the same period Of these, 89 (94.7%) of the 94 patients with whole body disease were treated with vitreoretinal surgery and 5 (5). 3% of patients with vitreoretinopathy treated with vitreoretinal surgery in 89 cases (98 eyes) were treated with vitreoretinal, 3 eyes (3.1%) were selected to be filled with heavy silicone oil. In 41 cases (46.1%), the whole body was treated with corticosteroids, 48 Corticosteroid hormone was not applied to the whole body due to general disease such as diabetes, 6 cases (60.7%) were used for the selection of antibiotics with small nephrotoxicity in the perioperative period of diabetic nephropathy.. 6 eyes (6. 1%) of silicone oil were filled with mild mycotic keratomy after operation. In the patients with vitreoretinopathy treated with vitreoretinal surgery, The age of the patients with the combination of the whole body was higher than that of the whole body (P = 0.000). The patients with the whole body (other than those with the exception of the injury) The number of days of hospital stay was longer than that of patients with whole body disease (other than injury) (P = 0.044). There were 23 eyes (23. 5%) with the same force and 13 eyes (1.3%) with a reduced vision. 4. 5%) heart rate was accelerated, 3 (3. 4%) heart rate decreased, 6 (6. 7%) blood pressure increased, and 5 cases (6. 7%). 5. Conclusion 1. The proportion of patients with whole body disease in the patients with eye disease is high, and the proportion of application of vitreoretinal surgery is high. Some of the patients with whole-body disease can't tolerate or communicate and reject the treatment of vitreous surgery; in some patients, the heart rate, the pressure of the blood pressure, the operation stress and the surrounding hand are caused by the operation of the patients. Intraoperative medication causes blood sugar, blood pressure fluctuation, and worsening of kidney disease, etc.; the fungal disease of the whole body can increase the probability of fungal infection in the eye; 2, raise the understanding of the interaction between the whole body disease and the vitreous surgery; and comprehensively assess the whole body's disease before the operation. The whole body condition is adjusted to the stable state, and the whole body is informed of the whole body disease and the operation risk through the communication. Intraoperative supervision To measure the whole body and adjust it in a timely manner, and select the appropriate intra-ocular filler;
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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