本文選題：血液透析 + 眼壓　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:研究慢性腎衰竭患者血液透析前后眼壓的變化與前房相關(guān)參數(shù)的關(guān)系,并探討眼壓變化的相關(guān)機(jī)制。方法:選取2015年1月至12月在我院腎內(nèi)科接受血液透析治療的慢性腎衰竭患者52例52眼(均取右眼為觀察眼),根據(jù)Shaffer分級(jí)法并結(jié)合超聲生物顯微鏡將52只眼分為四組:寬房角組、窄房角組、極窄房角組及閉角組。分別在血液透析前和透析結(jié)束后60sec內(nèi)采取患者靜脈血以計(jì)算血漿滲透壓。采用手持回彈式眼壓計(jì)分別在血液透析開始前30min內(nèi)、透析2h后和透析結(jié)束后30min內(nèi)測(cè)量眼壓。在血液透析前和透析后30min內(nèi),分別采用角膜內(nèi)皮細(xì)胞計(jì)數(shù)儀、眼部A超和超聲生物顯微鏡進(jìn)行中央角膜厚度、中央前房深度、晶狀體厚度、房角開放距離、小梁虹膜角、虹膜根部厚度和睫狀體厚度的測(cè)定。結(jié)果:血液透析后血漿滲透壓顯著降低,差異有統(tǒng)計(jì)學(xué)意義(t=3.04,P0.05)。血液透析不同時(shí)間點(diǎn)患者眼壓的均數(shù)不全相同(F=41.69,P0.01),即眼壓的變化具有時(shí)間差異性,其中透析前眼壓與透析2h眼壓相比差異有統(tǒng)計(jì)學(xué)意義(P0.01),透析后眼壓與透析2h眼壓相比差異有統(tǒng)計(jì)學(xué)意義(P0.01)。血液透析不同分組患者眼壓的均數(shù)不全相同(F=6.44,P0.01),即眼壓的變化具有組間差異性,其中寬房角組眼壓與極窄房角組眼壓相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),窄房角組眼壓和極窄房角組眼壓相比差異有統(tǒng)計(jì)學(xué)意義(P0.01)。此外,極窄房角組患者眼壓在透析2h較透析前明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。透析后眼壓又恢復(fù)至透析前的水平。血液透析后各組睫狀體厚度均變薄,只有寬房角組與透析前相比差異有統(tǒng)計(jì)學(xué)意義(t=2.61,P0.05)。血液透析后中央角膜厚度、中央前房深度、房角開角距離、小梁虹膜角和虹膜根部厚度均降低,而晶狀體厚度增加,但這些改變均沒有統(tǒng)計(jì)學(xué)意義。結(jié)論:血液透析對(duì)患者眼壓的影響與前房角的功能狀態(tài)相關(guān),其中極窄房角結(jié)構(gòu)是血液透析過(guò)程中眼壓升高的危險(xiǎn)因素,窄房角結(jié)構(gòu)可能是危險(xiǎn)因素,寬房角結(jié)構(gòu)的患者則相對(duì)安全。應(yīng)及早對(duì)血液透析患者進(jìn)行眼部篩查,并關(guān)注窄房角解剖結(jié)構(gòu)的患者。
[Abstract]:Aim: to study the relationship between intraocular pressure (IOP) and anterior chamber parameters in patients with chronic renal failure (CRF) before and after hemodialysis, and to explore the mechanism of IOP changes.Methods: 52 cases (52 eyes) of chronic renal failure treated by hemodialysis in our hospital from January to December 2015 were selected. 52 eyes were divided into two groups according to Shaffer classification and ultrasound biomicroscopy.Four groups: wide chamber angle group,Narrow angle group, very narrow angle group and closed angle group.Venous blood was taken to calculate plasma osmotic pressure in 60sec before and after hemodialysis, respectively.Intraocular pressure (IOP) was measured by handheld rebound intraocular pressure (IOP) in 30min before hemodialysis, 2 hours after dialysis and after dialysis.The central corneal thickness, central anterior chamber depth, lens thickness, angle open distance, trabecular iris angle and trabecular iris angle were measured before and after hemodialysis in 30min by corneal endothelial cell counter, eye A ultrasound and ultrasound biomicroscopy.Measurement of iris root thickness and ciliary body thickness.Results: the plasma osmotic pressure decreased significantly after hemodialysis, and the difference was statistically significant.The mean values of IOP in patients with hemodialysis at different time points were not all the same.There was significant difference between pre-dialysis IOP and 2h intraocular pressure (P 0.01), and there was significant difference in intraocular pressure (IOP) between 2 h after dialysis and 2 h after dialysis (P 0.01).The mean of intraocular pressure in different groups of hemodialysis patients was not the same as that in different groups of hemodialysis patients (P 0.01), that is, the change of intraocular pressure was different among groups.There was significant difference in intraocular pressure between wide angle group and very narrow angle group (P 0.05), and there was significant difference between narrow angle group and very narrow angle group (P 0.01).In addition, the IOP in the very narrow angle group was significantly higher than that before dialysis for 2 hours, and the difference was statistically significant (P 0.05).After dialysis, intraocular pressure returned to the level before dialysis.After hemodialysis, the thickness of ciliary body in each group was thinned, but there was significant difference between the wide angle group and pre-dialysis group.After hemodialysis, the central corneal thickness, the depth of the anterior chamber, the distance between the angle opening, the trabecular iris angle and the thickness of the iris root decreased, but the lens thickness increased, but these changes were not statistically significant.Conclusion: the effect of hemodialysis on intraocular pressure is related to the functional state of anterior chamber angle. The structure of extremely narrow atrial angle is a risk factor for the elevation of intraocular pressure during hemodialysis, and narrow angle structure may be a risk factor.Patients with wide angle structures are relatively safe.Eye screening should be carried out early for hemodialysis patients and attention should be paid to patients with anatomic structure of narrow atrium angle.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5;R771.3

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