本文選題：繃帶鏡　切入點：糖尿病　出處：《浙江大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:觀察糖尿病性視網(wǎng)膜病變患者玻璃體切割術(shù)后對角膜上皮的影響,探討角膜繃帶鏡對此類患者角膜上皮修復的作用。方法:選取2014年1月到2016年1月因糖尿病性視網(wǎng)膜病變在我院接受玻璃體切除術(shù)患者作為研究對象。入選前排除患有嚴重干眼、瞼緣炎等可能影響術(shù)后角膜上皮修復的疾病,將患者隨機分為觀察組和對照組。對照組患者術(shù)后接受常規(guī)藥物治療,觀察組患者在常規(guī)藥物治療的基礎(chǔ)上聯(lián)合使用繃帶鏡進行治療,分別在術(shù)后1天,1周,2周,3周,1月進行隨訪。觀察并比較兩組患者治療后的角膜上皮愈合情況,眼部癥狀、疼痛情況、視力,眼壓等,并對研究結(jié)果進行分析,采用SPSS 22.0進行統(tǒng)計分析。結(jié)果:隨訪期間共有符合條件患者46例(46眼),其中觀察組和對照組各23例(23眼)。術(shù)前觀察組BUT平均值為7.81±3.21s,對照組為8.01±2.10s,兩組間差別沒有統(tǒng)計學意義(t=0.234,P=0.612);觀察組淚液分泌試驗平均值為10.73±6.12mm,對照組11.02±5.62mm,兩組間差別無明顯統(tǒng)計學差異(t=0.306,P=0.412)。對照組患者角膜上皮愈合時間5天到62天,平均21.6±11.2天,持續(xù)性角膜上皮缺損11例,觀察組角膜上皮愈合時間3天到42天,平均13.3±8.4天,其中持續(xù)性角膜上皮缺損超過2周患者5例。兩組間差別有統(tǒng)計學意義(t=2.631,p=0.003)。兩組患者在接受治療后,第一周愈合例數(shù)(觀察組11例,占47.8%,對照組4例,占17.3%),第二周(觀察組18例,占比例78.3%,對照組為12例,占52.1%),觀察組角膜上皮愈合時間大大縮短,其中觀察組1例患者因繃帶鏡貼合不緊密致上皮愈合時間超過6周。兩組患者眼部舒適度比較,第一周患者眼部異物感觀察組0.34±0.27分,對照組0.53±0.22分(χ2=2.6163,P=0.0121);眼部刺痛觀察組0.69±0.25分,對照組0.96±0.21分(χ2=3.96,P=0.0003);畏光流淚觀察組 0.41±0.39 分,對照組 0.65±0.33(χ2=2.253,P=0.0293),觀察組明顯優(yōu)于對照組患者。隨著兩組角膜上皮的逐漸愈合,其舒適度在后期逐漸接近,但前3周內(nèi)其評分仍存在統(tǒng)計學差異。眼部疼痛方面比較,第一周觀察組0.5級有22例(95.65%),1級僅為1例,沒有2級疼痛患者;對照組0.5級有16例(69.57%),1級6例(26.09%),2級疼痛1例(4.35%),觀察組在0.5級及1級疼痛上明顯優(yōu)于對照組(0.5級χ2=4.072,P=0.044;1級χ2=16.133,P=0.000)。結(jié)論:角膜上皮持續(xù)不愈合是糖尿病性視網(wǎng)膜病變患者術(shù)后常見的眼表并發(fā)癥,角膜繃帶鏡能顯著促進糖尿病性視網(wǎng)膜病變患者玻璃體切除術(shù)后角膜上皮的愈合,對減輕患者眼部癥狀和提高生活質(zhì)量具有很重要的作用。
[Abstract]:Objective: to observe the effect of vitrectomy on corneal epithelium in patients with diabetic retinopathy. Objective: to investigate the effect of corneal bandage on corneal epithelium repair in patients with diabetic retinopathy from January 2014 to January 2016. The patients undergoing vitrectomy in our hospital from January 2014 to January 2016 were selected as subjects. With the exception of severe dry eyes, The patients were randomly divided into observation group and control group. The patients in the control group received routine drug treatment after operation. The patients in the observation group were treated with bandage lens on the basis of routine drug therapy. The patients in the observation group were followed up on 1 day, 1 week, 2 weeks and 3 weeks, January, respectively. The healing of corneal epithelium and ocular symptoms were observed and compared between the two groups. Pain, visual acuity, intraocular pressure, etc., and analysis of the results of the study, SPSS 22.0 was used for statistical analysis. Results: during the follow-up period, 46 eyes of 46 eligible patients were diagnosed, 23 eyes of the observation group and 23 cases of the control group, the mean BUT of the preoperative observation group was 7.81 鹵3.21 seconds, the control group was 8.01 鹵2.10 s, the difference between the two groups was not uniform. The mean value of tear secretion test was 10.73 鹵6.12mm in the observation group and 11.02 鹵5.62mm in the control group. There was no significant difference between the two groups. The healing time of corneal epithelium in the control group was 5 days to 62 days. Mean 21.6 鹵11.2 days and persistent corneal epithelial defects in 11 cases. The healing time of corneal epithelium in the observation group ranged from 3 days to 42 days, with an average of 13.3 鹵8.4 days. There were 5 patients with persistent corneal epithelial defect for more than 2 weeks. The difference between the two groups was statistically significant. The patients in the two groups healed in the first week after treatment (11 cases in the observation group, 47.8 cases in the control group, 4 cases in the control group, 17.3%), the second week (18 cases in the observation group, 18 cases in the observation group, 18 cases in the observation group). There were 12 cases in the control group, accounting for 52.1%. The healing time of corneal epithelium in the observation group was greatly shortened, and the healing time of the epithelial epithelium in the observation group was more than 6 weeks due to the lack of bandage. The eye comfort of the two groups was compared. In the first week, the ocular foreign body sensation in the observation group was 0.34 鹵0.27, in the control group 0.53 鹵0.22 (蠂 ~ 2 / 2, 2.6163), in the eye tingling group was 0.69 鹵0.25, and in the control group was 0.96 鹵0.21 (蠂 ~ 2, 3.96, P ~ (0.0003); 0.41 鹵0.39 in photophobia observation group, respectively). The control group was 0.65 鹵0.33 (蠂 ~ 2 + 2.253), the observation group was obviously superior to the control group. With the gradual healing of corneal epithelium between the two groups, the degree of comfort gradually approached at the later stage, but there was still a statistical difference in the score within the first 3 weeks. In the first week, 22 cases of grade 0.5 were in the observation group, only 1 case was in grade 1, and there was no pain in grade 2. In the control group, there were 16 cases of grade 1 (69.57) and 6 cases of grade 1 (26.0909) with pain of grade 2 (4.35). The pain in the observation group was significantly better than that in the control group in grade 0.5 and grade 1 (蠂 24.072P 0.044 P 0.044) P 0.000.Conclusion: the persistent nonunion of corneal epithelium is common in the patients with diabetic retinopathy after operation. Eye surface complications, Corneal bandage can significantly promote the healing of corneal epithelium after vitrectomy in patients with diabetic retinopathy. It plays an important role in alleviating the ocular symptoms and improving the quality of life of patients with diabetic retinopathy.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R779.6;R587.2

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