本文選題：白內(nèi)障　切入點(diǎn)：術(shù)前視力　出處：《大連醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：與2000年相比，2010年中國(guó)老齡人口從7%增加到8.9%，老齡人口逐漸增加，患老年性白內(nèi)障的人數(shù)也在逐年增加。視力是白內(nèi)障手術(shù)的重要指征之一。中國(guó)1999年的百萬人口白內(nèi)障手術(shù)率（cataract surgery rate，CSR）是318.3,在2009年CSR達(dá)796.2。10年之間白內(nèi)障手術(shù)量增加了近3倍，但是白內(nèi)障手術(shù)術(shù)前視力仍多以0.3及以下為主，尤其以防盲為目的的白內(nèi)障手術(shù)嚴(yán)格控制在0.3及以下。本研究的目的是調(diào)查過去的十年間沈陽地區(qū)老年性白內(nèi)障手術(shù)術(shù)前視力變化情況，為防治老年性白內(nèi)障導(dǎo)致的視力殘疾的防治提供流行病學(xué)依據(jù)及指導(dǎo)性建議。 方法：調(diào)查沈陽何氏眼科醫(yī)院2000年第四季度及2010年第四季度所做老年性白內(nèi)障手術(shù)的術(shù)前視力情況，共計(jì)388眼。根據(jù)患者接受手術(shù)時(shí)間的先后，將同一患者接受雙眼白內(nèi)障手術(shù)的，分成第一眼手術(shù)和第二眼手術(shù)；僅接受一只眼手術(shù)的均認(rèn)為是第一眼手術(shù)，其中第一眼手術(shù)量316眼，第二眼手術(shù)量72眼。2010年第一眼手術(shù)量224例，第二眼手術(shù)量46例，總計(jì)270例。2000年第一眼手術(shù)量92例，第二眼手術(shù)量26例�？傆�(jì)118例。 建立白內(nèi)障手術(shù)患者數(shù)據(jù)庫。手術(shù)信息2000年來自沈陽何氏眼科醫(yī)院手術(shù)記錄本，2010年來自沈陽何氏眼科醫(yī)院電子手術(shù)記錄。其他信息來自何氏眼科醫(yī)院門診及住院病案記載。 視力分級(jí)標(biāo)準(zhǔn)參照國(guó)家制定的視力殘疾標(biāo)準(zhǔn) 主要統(tǒng)計(jì)指標(biāo)：術(shù)前矯正視力、年齡、性別。 統(tǒng)計(jì)分析使用SPS11.5統(tǒng)計(jì)軟件，在windows系統(tǒng)運(yùn)行。采用卡方檢驗(yàn)、秩和檢驗(yàn)和t檢驗(yàn)分析，檢驗(yàn)水準(zhǔn)α=0.05,以P0.05作為差異有統(tǒng)計(jì)學(xué)意義的標(biāo)準(zhǔn)。 結(jié)果：1、2010年與2000年相比，第一眼白內(nèi)障手術(shù)，術(shù)前視力明顯提高（P=0.004）。第二眼白內(nèi)障手術(shù)，術(shù)前視力差別無統(tǒng)計(jì)學(xué)意義（P=0.680）。 2、第一眼術(shù)前矯正視力分布2010年與2000年分布明顯不同 （χ2=11.241，P=0.024），第二眼兩年無差別（χ2=3.075，P=0.545）。第一眼術(shù)前視力，4級(jí)盲下降，從55%降至36%；3級(jí)盲及1級(jí)低視力增加，3級(jí)盲從5%增至13%，1級(jí)低視力從18%增至29%；2級(jí)低視力和0.3及以上沒有變化。 3、2010年第一只眼手術(shù)的年齡（69.99±10.153歲）較2000年（66.73±7.877歲）明顯增大（t=-3.063，P=0.002）。第二只眼，白內(nèi)障手術(shù)年齡差別無統(tǒng)計(jì)學(xué)意義（t=0.245, P=0.807）。 4、在第一眼手術(shù)時(shí)，男性2010年手術(shù)年齡（69.70±10.888歲）大于2000年手術(shù)年齡（64.80±9.27歲）（t=-2.38，P=0.019）；女性2010年術(shù)前平均年齡70.23±9.546歲，2000年67.91±6.701歲，兩年間比較差別無統(tǒng)計(jì)學(xué)意義。（t=-1.651，P=0.1）。在第二眼手術(shù)時(shí)，男性和女性手術(shù)年齡在兩年之間差別均無統(tǒng)計(jì)學(xué)意義（P0.05） 5、2010年與2000年相比，在第一只眼，手術(shù)年齡分布有統(tǒng)計(jì)學(xué)差異（χ2=28.271，P=0.000），在第二眼手術(shù)年齡分布差別無統(tǒng)計(jì)學(xué)意義（P=0.165）。在第一眼，2010年與2000年相比，75歲及以上年齡組手術(shù)患者所占比例明顯增加，65-74歲年齡組手術(shù)患者所占比例明顯下降，45-64歲年齡組變化不明顯。 6、第一只眼和第二只眼白內(nèi)障手術(shù)，男女術(shù)前視力比較均無明顯差別。 7、第一只眼和第二只眼白內(nèi)障手術(shù)，術(shù)前視力與年齡均無關(guān)。 8、第一只眼白內(nèi)障手術(shù)，術(shù)前視力與合并眼病有關(guān)（χ2=10.920，，P=0.027）；在第二只眼，術(shù)前視力與合并眼病無關(guān)（χ2=8.958，P=0.062）。 結(jié)論：2010年與2000年相比，白內(nèi)障手術(shù)術(shù)前視力水平提高，并且術(shù)前4級(jí)盲明顯減少，3級(jí)盲增加，1級(jí)低視力增加，2級(jí)低視力、0.3及以上變化不明顯。白內(nèi)障盲大大減少。有更多的老年人（年齡在75歲以上）接受白內(nèi)障手術(shù)，更多視力損傷較輕的人接受手術(shù)。與此同時(shí)，手術(shù)患者平均年齡增加。視力受合并眼部其它影響視力的疾病影響，與年齡、性別無關(guān)。
[Abstract]:Objective: compared with 2000, 2010 China aging population increased from 7% to 8.9%, the aging population gradually increased and the number of people suffering from senile cataract is increasing year by year. Visual cataract surgery is an important indication of cataract surgery in 1999. Millions of people Chinese rate (cataract surgery rate, CSR) is 318.3, up to the amount of cataract surgery between 796.2.10 to CSR in 2009 increased by nearly 3 times, but the cataract surgery preoperative visual acuity is 0.3 and below, especially in the prevention of cataract surgery for the purpose of strict control in 0.3 and below. The purpose of this study is to investigate the past ten years in Shenyang area of senile cataract surgery preoperative visual acuity, provide epidemiological basis and guidance for the prevention and treatment of senile cataract resulting in visual disability prevention.
Methods: the visual acuity survey in Shenyang He Eye Hospital in 2000 fourth quarter and the fourth quarter of 2010 the senile cataract surgery before the operation, a total of 388 eyes of patients underwent surgery. According to the time sequence of the same patient underwent bilateral cataract surgery, divided into the first eye surgery and second eyes received only one eye surgery operation; are believed to be the first eye operation, wherein the first eye surgery in 316 eyes, second eyes and 72 eyes in the first surgery.2010 eye surgery 224 cases, second eyes surgery in 46 cases, a total of 270 cases of the first year.2000 eye surgery in 92 cases, second eyes surgery in 26 cases. A total of 118 cases.
A database of cataract surgery patients was established. Operative information was collected from the surgical records of Ho's eye hospital in Shenyang in 2000, and electronic surgery records from Ho's Eye Hospital of Shenyang in 2010. Other information is from the outpatient and inpatient records of Ho's ophthalmology hospital.
Vision classification standards refer to the national standard of visual disability
Main statistical indicators: preoperative correction of visual acuity, age, and sex.
Statistical analysis was carried out in the windows system using SPS11.5 statistical software. Chi square test, rank sum test and t test were used to test the level of alpha =0.05, and P0.05 was used as a standard with statistically significant difference.
Results: in 12010 years compared with 2000, the first cataract surgery had significantly improved visual acuity before operation (P=0.004). There was no significant difference in visual acuity between second eyes before cataract surgery (P=0.680).
2. The distribution of corrected visual acuity in the first eye was significantly different between 2010 and 2000
(x 2=11.241, P=0.024), there was no difference between the second eyes (chi 2=3.075, P=0.545). The first eye visual acuity, the 4 grade blindness decreased from 55% to 36%, the 3 grade blindness and 1 grade low vision increased, 3 grade blind 5% increased to 13%, 1 grade low vision increased from 18% to 18%, and there was no change in the low grade vision and above or above.
In 32010 years, the age of operation in the first eye (69.99 + 10.153 years) increased significantly compared with that in 2000 (66.73 + 7.877 years). There was no significant difference in the age of cataract between second eyes (t=-3.063, P=0.002) (t=0.245, P=0.807).
4, in the first eye surgery, male 2010 operation age (69.70 + 10.888) than the 2000 operation age (64.80 + 9.27 years) (t=-2.38, P=0.019); 2010 women preoperative mean age 70.23 + 9.546, 67.91 + 6.701 years in 2000, two years there was no significant difference (t=-1.651, P=0.1). In second eye surgery, male and female operation at the age of two years between the difference was not statistically significant (P0.05)
52010 compared with 2000, in the first eye, there were significant differences in operative age distribution (x 2=28.271, P=0.000), there was no significant difference in the age distribution of the second eye surgery (P=0.165). At first glance, in 2010 compared with 2000, patients aged 75 years and above age group the proportion increased significantly, 65-74 year old age group the proportion of patients decreased significantly, 45-64 year old age group did not change significantly.
6, first eye and second eye cataract surgery, there was no significant difference in visual acuity between men and women before operation.
7, first eye and second eye cataract surgery, preoperative vision was not related to age.
8, in the first cataract surgery, preoperative visual acuity was associated with eye disease (chi 2=10.920, P=0.027). In second eyes, preoperative visual acuity was not associated with eye disease (chi 2=8.958, P=0.062).
Conclusion: 2010 compared with 2000, cataract surgery preoperative visual acuity improved, and preoperative grade 4 blind was significantly reduced, 3 blind increase, 1 low vision increased, 2 low vision, 0.3 and above did not change significantly. Cataract blindness greatly reduced. There are more elderly people (aged over 75) accept cataract surgery, more visual acuity less injury who underwent surgery. At the same time, the average age of patients increased. Visual acuity was associated with eye disease affecting the visual effect of the other, with age and gender.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R779.6

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