本文選題：增殖性糖尿病視網(wǎng)膜病變 + 康柏西普��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)比觀察單行經(jīng)睫狀體平坦部閉合式三通道23G玻璃體切除術(shù)(Pars plana vitrectomy,PPV)與玻璃體腔內(nèi)注射康柏西普聯(lián)合23G玻璃體切除術(shù)對(duì)增殖性糖尿病視網(wǎng)膜病變(Proliferative diabetic retinopathy,PDR)的手術(shù)操作及臨床效果的影響。方法:回顧性病例分析。從2014-12/2015-12我院收治的PDR患者中隨機(jī)選取23例26眼。按照隨機(jī)法將其分為兩組,對(duì)照組:共11例12眼,入院后單行經(jīng)睫狀體平坦部閉合式三通道23G玻璃體切除術(shù)治療;試驗(yàn)組:共12例14眼,入院后先于玻璃體腔內(nèi)注射康柏西普0.5mg/0.05ml,注射后6-8d行23G玻璃體切除術(shù)。記錄兩組PDR患者術(shù)前基本情況(如性別、年齡、術(shù)前空腹血糖、糖尿病病程等)及術(shù)前最佳矯正視力(best corrected visual acuity,BCVA)、眼壓(intraocular pressure,IOP)、眼底照相、光學(xué)相干斷層掃描(optical coherence tomography,OCT)測(cè)得的術(shù)后黃斑中心凹厚度(central macular thickness,CMT)。術(shù)后隨訪半年以上,觀察并分析兩組PDR患者的手術(shù)情況(如平均手術(shù)時(shí)間、術(shù)中出血、醫(yī)源性裂孔發(fā)生率、硅油填充率等),術(shù)后每月BCVA、IOP、CMT等臨床指標(biāo)及隨訪期間嚴(yán)重眼部、全身并發(fā)癥的發(fā)生率。結(jié)果:兩組PDR患者手術(shù)情況比較:試驗(yàn)組患者的平均手術(shù)時(shí)間、術(shù)中嚴(yán)重出血率均少于對(duì)照組,分別是(75.64±18.73)min vs(95.36±14.74)min,14.3%vs 58.3%,且P0.05,差異具有統(tǒng)計(jì)學(xué)意義。術(shù)中發(fā)生醫(yī)源性裂孔眼數(shù),試驗(yàn)組3眼(21.4%),對(duì)照組5眼(41.7%)。術(shù)中需使用硅油填充玻璃體腔眼數(shù),試驗(yàn)組4眼(28.6%),對(duì)照組8眼(66.7%)。術(shù)后因復(fù)發(fā)玻璃體積血及視網(wǎng)膜脫離行2次手術(shù)眼數(shù),試驗(yàn)組1眼(7.1%),對(duì)照組2眼(16.7%)。試驗(yàn)組與對(duì)照組患者術(shù)前黃斑中心凹厚度分別為(441.92±146.92)μm、(452.23±159.62)μm,差異無統(tǒng)計(jì)學(xué)意義。術(shù)后4mo時(shí)黃斑中心凹厚度分別為(214.91±30.15)μm、(318.92±156.17)μm,P0.05,差異具有統(tǒng)計(jì)學(xué)意義。試驗(yàn)組與對(duì)照組患者術(shù)前最佳矯正視力分別為(20.65±26.53)、(22.29±21.78),差異無統(tǒng)計(jì)學(xué)意義。術(shù)后4mo時(shí)最佳矯正視力分別為(56.25±22.90)、(38.57±24.72),P0.05,差異具有統(tǒng)計(jì)學(xué)意義。試驗(yàn)組患者行康柏西普玻璃體腔內(nèi)注射后,有1例出現(xiàn)一過性眼壓升高,眼壓為27mmHg,未予特殊處理,于次日恢復(fù)至正常范圍。兩組PDR患者治療隨訪期內(nèi)均未發(fā)生嚴(yán)重全身并發(fā)癥。結(jié)論:對(duì)于增殖性糖尿病視網(wǎng)膜病變的患者,行玻璃體切除術(shù)前于玻璃體腔內(nèi)注射康柏西普0.5mg/0.05ml,可以有效的促進(jìn)眼內(nèi)新生血管消退,大大減少術(shù)中出血,縮短玻璃體切除術(shù)手術(shù)時(shí)間,并降低醫(yī)源性裂孔的發(fā)生率及硅油填充率,易化手術(shù)操作,同時(shí)可使患者黃斑水腫減輕,提高患者的最佳矯正視力。
[Abstract]:Objective: to compare the effects of single transciliary flat three-channel three-channel vitrectomy (PPV) with intravitreal injection of Compactopril and 23G vitrectomy on proliferative diabetic retinopathy (PDR) in patients with proliferative diabetic retinopathy.The effect of operation and clinical effect.Methods: retrospective analysis of cases.Twenty-three patients (26 eyes) with PDR were randomly selected from 2014-12 / 2015-12.They were randomly divided into two groups: control group (n = 11, 12 eyes) and experimental group (n = 12, n = 14).After admission, Comborsup 0.5 mg / 0. 05 ml was injected into the vitreous cavity, and 23 G vitrectomy was performed 6-8 days after the injection.The basic preoperative conditions (such as gender, age, preoperative fasting blood glucose, course of diabetes, etc.), the best corrected visual acuity and intraocular pressure IOP, fundus photography were recorded in the two groups of patients with PDR.The thickness of the central foveal fovea of macula was measured by optical coherence tomography (Oct) and central macular thicknessen (CMT).Two groups of patients with PDR were followed up for more than half a year. The operation time, intraoperative bleeding, iatrogenic hole rate, silicone oil filling rate and so on were observed and analyzed.Incidence of systemic complications.Results: the average operation time and severe bleeding rate in the trial group were lower than those in the control group, which were 75.64 鹵18.73)min vs(95.36 鹵14.74 min 14.3 vs 58.3 min, and the difference was statistically significant (P 0.05).The number of iatrogenic holes occurred in the treatment group (3 eyes) and the control group (5 eyes).The number of vitreous cavity eyes filled with silicone oil was 28.6 eyes in the test group and 66.7 eyes in the control group.The number of eyes with recurrent vitreous hemorrhage and retinal detachment was 7. 1 in the experimental group and 16. 7 in the control group.The thickness of macular fovea was 441.92 鹵146.92 渭 m in the experimental group and 452.23 鹵159.62 渭 m in the control group, respectively. There was no significant difference between the two groups.The thickness of macular fovea was 318.92 鹵156.17 渭 m after 4mo, and the thickness of fovea was 214.91 鹵30.15 渭 m (P 0.05).The preoperative best corrected visual acuity (BCVA) in the test group and the control group was 20.65 鹵26.53 and 22.29 鹵21.78, respectively. There was no significant difference between the two groups.The best corrected visual acuity after 4mo was 56.25 鹵22.90 and 38.57 鹵24.72, respectively. The difference was statistically significant.In the test group, one patient who received intravitreal injection of Comborsup showed a transient elevation of intraocular pressure (IOP) of 27mm Hg, which was recovered to normal range on the next day without special treatment.There were no severe systemic complications in the two groups of PDR patients during the follow-up period.Conclusion: for patients with proliferative diabetic retinopathy, intravitreous injection of Compactopril 0.5 mg / 0.05 ml before vitrectomy can effectively promote intraocular neovascularization and reduce intraoperative bleeding.Shortening the time of vitrectomy, reducing the incidence of iatrogenic hole and silicone oil filling rate, facilitating the operation, at the same time, can reduce the macular edema of patients and improve the best corrected visual acuity of patients.
【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)】：R779.6;R587.2

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相關(guān)期刊論文 前7條

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本文編號(hào)：1738683