硅油乳化相关因素体外研究

发布时间：2018-03-19 21:26

本文选题：硅油　切入点：乳化　出处：《郑州大学》2010年硕士论文　论文类型：学位论文

【摘要】： 眼科使用的硅油产品材料为聚二甲基硅氧烷(Polydimethylsiloxane,PDMS),基本分子单位是-(CH3)2-Si-O-,20℃时屈光指数1.404,与玻璃体的屈光指数1.336近似。硅油具有良好的光学透明性,疏水性,理化性能稳定,毒性低,生理惰性和有效的表面张力,填充作用持久,能防止出血和纤维收缩等理化性质,已经广泛应用于临床治疗多种复杂视网膜脱离,但同时其长期填充于眼内带来的多种并发症严重影响手术后的远期疗效,不容忽视。其中硅油乳化就是存在的比较严重的后期并发症之一。硅油乳化大多学者认为是填充玻璃体腔内的硅油大泡分离出稳定不透明的硅油小泡,呈粉尘状小滴贴附于眼内组织或扩散入眼周边组织。乳化颗粒游动于玻璃体腔、前房或黏附在视网膜、虹膜表面,引起角膜、晶状体病变或阻塞小梁网继发青光眼或进入眼周组织干扰眼生理引发一系列的并发症。硅油乳化的发生原因至今难以定论,发生率约为0.7%～40%,是近些年困扰眼科临床医师的难题之一,国内外对硅油乳化相关因素的基础研究和临床观察也是近些年的热门课题。本实验旨在体外研究分析手术过程中接触到的临床相关因素：平衡盐溶液(balanced salt solution, BSS),曲安奈德,全氟萘烷,新鲜血清,以及长期饮酒患者血液中乙醇成分对硅油乳化的影响,建立有效的体外促乳化模型,为今后硅油乳化防治的深入研究和眼内填充物性状改善提供依据。材料和方法使用特制5ml容量瓶体外仿效人眼模型,于其中加入不同的干扰因素：纯平衡盐溶液0.5ml和硅油(法国Arciolane 5500cs)4.0ml配置作为对照组,曲安奈德、新鲜血清、全氟萘烷、无水乙醇的BSS的溶液各0.5ml和硅油4.0ml配置作为实验组,在37℃置于恒温气浴摇床中,振荡速度120转/分,由一名非相关实验人员在暗视野显微镜下观察1周、2周、4周、8周每组硅油乳化情况并计数乳化颗粒数目。结果 1.每个参与实验的组在不同时间相比差异均是(p0.05),结果有统计学意义,表示随时间延长乳化颗粒均有增加趋势。 2.曲安奈德组与对照BSS组每个时间乳化颗粒数目相比,使用成组定量资料t检验结果均是(p0.05),结果有统计学意义,乳化硅油小滴数目有所减少。 3.全氟萘烷(重水)组与对照BSS组每个时间乳化颗粒数目相比,使用成组定量资料t检验结果均是(p0.05),结果有统计学意义,乳化硅油小滴数目有所增加。 4.新鲜血清组与对照BSS组在1W、2W、4W时间相比,使用成组定量资料t检验结果均是(p0.05),结果有统计学意义,乳化硅油小滴数目有所减少;8W分析结果是(t=-1.276,p0.05),结果没有统计学意义,认为8周曲安奈德组与BSS组乳化颗粒数目没有差别。 5.无水乙醇组与对照BSS组在1W、2W、4W时间相比,使用成组定量资料t检验结果均是(p0.05),结果有统计学意义,乳化硅油小滴数目有所减少；8W时间统计(t=-14.586,p0.05),结果有统计学意义,认为8W无水乙醇组比BSS组乳化颗粒数目多。结论 1.成功建立眼模型体外实验虽不能完全模拟体内环境,但能统一众多繁杂因素,分析手术相关接触因素对硅油乳化的效能。 2.在临床意义上完全避免接触干扰因素是不可能的,全氟萘烷可能增加硅油乳化,故手术中尽量减少全氟萘烷应用；手术过程中应用曲安奈德,有可能减少硅油乳化的发生；血液成分、乙醇成分渗出玻璃体腔,可能影响手术后远期硅油乳化量,术中、术后应控制出血、避免饮酒。
[Abstract]:Silicone products for ophthalmic use materials two polydimethylsiloxane (Polydimethylsiloxane, PDMS), the basic unit is the molecular - (CH3) 2-Si-O-, 20 DEG C when the refractive index of 1.404, and the refractive index of 1.336 vitreous body approximation. Silicone oil has good optical transparency, hydrophobicity, stable physicochemical properties, low toxicity, physiological inertia and effective surface tension, with lasting effect, can prevent bleeding and shrinkage and other physicochemical properties, has been widely used in clinical treatment of complicated retinal detachment, but its long-term complications in the eye filled with a variety of serious long-term effect, after the operation can not be ignored. One of the more serious complications of silicone oil emulsion is there.
Most scholars believe that the silicone oil emulsion is filled with intravitreal silicone oil bubble isolated opaque silicone oil vesicles are stable, dust like droplets attached to the intraocular tissue or surrounding tissues. Emulsion particles diffusion by swimming in the anterior chamber or vitreous cavity, the surface adhesion in the retina, iris, corneal lens, or obstruction of the trabecular meshwork secondary lesion glaucoma or enter the eye tissue interference eye physiological cause a series of complications. Causes of silicone oil emulsion has been difficult to determine, the incidence rate is about 0.7% ~ 40%, is one of the difficult problems in recent years by ophthalmic clinicians, hot topics of study abroad based on silicone oil emulsification related factors and clinical observation is also in recent years.
The purpose of this experiment was to study the in vitro clinical factors related to exposure during surgery: balanced salt solution (balanced salt, solution, BSS), triamcinolone acetonide, perfluorodecalin, fresh serum, and the long-term effects of drinking alcohol components in blood of silicone oil emulsion, establishing an effective in vitro model for the further study of emulsion. And intraocular silicone oil emulsification prevention filling characters provide a basis for improving.
Materials and methods
The use of special 5ml volumetric flask in vitro follow the human model, in which added different interference factors: pure balanced salt solution 0.5ml and silicone oil (French Arciolane 5500cs) 4.0mL configuration as control group, triamcinolone acetonide, fresh serum, perfluorodecalin solution, ethanol BSS 0.5ml 4.0mL configuration and silicone oil as the experimental group, in 37 C in a constant temperature air bath shaker, oscillation speed of 120 rpm, by a non experimental personnel in the dark field microscopy observation of 1 weeks, 2 weeks, 4 weeks, 8 weeks the number of silicone oil emulsion and emulsion particle counting.
Result
1. the differences in each group were (P0.05) at different times, and the results were statistically significant, indicating that the emulsified particles increased with time.
2. triamcinolone acetonide group compared with the control group BSS, the number of each time of emulsion particles, using a group of quantitative data t test results are (P0.05), the results were statistically significant, the number of emulsified silicone oil droplets decreased.
3. perfluorodecalin (D2O) group compared with the control group each time the number of BSS emulsion particles, using a group of quantitative data t test results are (P0.05), the results were statistically significant, increase in the number of vesicles of emulsified silicone oil.
4. fresh serum group and control group BSS in 1W, 2W, 4W time compared to the use of group T results are quantitative data (P0.05), the results were statistically significant, the number of emulsified silicone oil droplets decreased; the results of 8W analysis is (t=-1.276, P0.05), the results were not statistically significant, that there is no difference between the number of 8 weeks of triamcinolone acetonide group BSS and group of emulsion particles.
The 5. ethanol group and control group BSS in 1W, 2W, 4W time compared to the use of group T results are quantitative data (P0.05), the results were statistically significant, emulsified silicone oil droplets number decreased; 8W time statistics (t=-14.586, P0.05), the results were statistically significant, as 8W ethanol group than in the BSS group number of emulsion particles.
conclusion
1. the successful establishment of eye model in vitro can not simulate the internal environment completely, but it can unify many complicated factors, and analyze the effect of surgical related factors on the emulsification of silicone oil.
2. in the clinical sense to completely avoid exposure to interference factors is not possible, perfluorodecalin may increase the emulsification of the silicone oil the surgery to minimize perfluorodecalin application; the application of Cu Ann Ned during the surgery, may reduce the occurrence of silicone oil emulsion; blood components, components of alcohol may affect the exudation of the vitreous surgery after long-term silicone oil the amount of emulsion, intraoperative, postoperative bleeding should be controlled, to avoid alcohol.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R779.6

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