本文選題：增生性糖尿病視網膜病變 + 曲安奈德�。� 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討玻璃體切除手術治療增生性糖尿病視網膜病變(proliferative diabetic retinopathy,PDR)過程中,眼內應用曲安奈德(Triamcinolone acetonide,TA)對于術中止血的作用及其可能作用機制。方法:第一部分:玻璃體切除手術治療嚴重PDR患者25人29只眼,術中首先盡可能切除干凈玻璃體及容易剝除的增生膜。在剝除增生膜時發(fā)生視網膜出血或小血管出血,此時向眼內注入TA(4mg/0.1ml),然后繼續(xù)切除殘存的玻璃體和增生膜。記錄患者視網膜術中、術后出血情況,術后最佳矯正視力、眼壓及并發(fā)癥。第二部分:因PDR接受玻璃體切除手術并且術中眼內應用TA治療的患者共12例12只眼,為TA組;因黃斑前膜或裂孔接受玻璃體切除手術32例32只眼,為對照組。TA組術中眼內應用TA與第一部分方法相同。在玻璃體切除手術開始時對所有患眼均采集玻璃體樣本,采用雙抗體夾心法酶聯(lián)免疫吸附實驗法(enzyme linked immunosorbent assay-sandwich technique,ELISA)分別測定TA組和對照組患者玻璃體中尿激酶纖溶酶原激活物(urokinase plasminogen activator,u-PA)、組織纖溶酶原激活物(tissue plasminogen activator,t-PA)及纖溶酶原激活物抑制劑(plasminogen activator inhibitors 1,PAI-1)含量,同時比較TA組和對照組之間上述指標含量差異。結果:第一部分:術中所有眼于TA注射后,視網膜顏色稍微變淺,視網膜滲血及小血管出血減輕或停止。術后1周及1個月分別觀察到9只眼(31.03%)及4只眼(13.79%)有少量殘存視網膜出血。術后3個月,所有視網膜出血吸收(100%)。末次隨訪,視力提高25只眼(86.21%),視力不變4只眼(13.79%),未觀察到視力下降者。術后早期眼壓升高8只眼(27.59%),其中7只眼經抗青光眼藥物治療,2周內眼壓恢復正常;1只眼于術后1個月行小梁切除術,術后眼壓得到控制。白內障進展加重3只眼(21.43%)。隨訪期間未觀察到視網膜再出血、眼內炎及其他并發(fā)癥。第二部分TA組u-PA中位數(shù)為25.45ng/m L,t-PA中位數(shù)為127.44ng/m L,PAI-1中位數(shù)為0.42ng/m L。對照組u-PA中位數(shù)為22.94ng/m L,t-PA中位數(shù)為142.37ng/m L,PAI-1中位數(shù)為0.27ng/m L。TA組玻璃體u-PA含量顯著高于對照組,差異有統(tǒng)計學意義(Z=-2.268,P0.05),而玻璃體t-PA和PAI-1含量在TA組和對照組之間無顯著性差異(Z=-0.092、-1.847,P值均0.05)。結論:玻璃體切除治療PDR于術中適當時機向眼內注射TA可有效控制術中視網膜出血,使手術時間縮短,手術安全性提高。PDR患者玻璃體u-PA含量高,導致眼內容易引起出血。玻璃體切除手術中眼內應用TA可能通過降低t-PA和u-PA水平而降低出血傾向,而通過增加PAI-1水平來達到止血作用。
[Abstract]:Objective: to investigate the effect of triamcinolone acetonide during vitrectomy in the treatment of proliferative diabetic retinopathy (PDR) and its possible mechanism. Methods: the first part: vitrectomy was performed on 29 eyes of 25 patients with severe PDR. Retinal haemorrhage or small vessel hemorrhage occurred during the exfoliation of the proliferative membrane, and then the residual vitreous and proliferative membranes were continued to be removed by injecting TAA 4 mg / 0.1 ml into the eye. Postoperative bleeding, postoperative best corrected visual acuity, intraocular pressure and complications were recorded. The second part: 12 cases (12 eyes) received vitrectomy for PDR and 12 eyes for intraocular TA, 32 cases (32 eyes) received vitrectomy because of macular membrane or hole, 32 cases (32 eyes) received vitrectomy because of macular membrane or hole, and 32 eyes (32 eyes) received vitrectomy because of macular membrane or hole. The intraocular application of TA in the control group was the same as that in the first part. Vitreous samples were collected from all affected eyes at the beginning of vitrectomy. Determination of urokinase plasminogen activator u-PA-PAA, tissue plasminogen activator tissue plasminogen activator t-PAA and plasminogen activation in vitreous of TA group and control group by enzyme-linked immunosorbent assay (Elisa) with double antibody sandwich enzyme-linked immunosorbent assay (Elisa) The content of plasminogen activator inhibitors 1 (PAI-1), At the same time, the contents of above indexes were compared between TA group and control group. Results: in the first part, all eyes were injected with TA, the retinal color was slightly lighter, retinal blood leakage and small vessel hemorrhage were alleviated or stopped. Retinal hemorrhage was observed in 9 eyes (31. 03%) and 4 eyes (13. 79%) at 1 week and 1 month after operation. After 3 months, all retinal hemorrhage absorbed 100 times. At the last follow-up, the visual acuity was improved in 25 eyes (86.21 eyes), and the visual acuity was unchanged in 4 eyes (13.79%). Early postoperative intraocular pressure was increased in 8 eyes (27.59%), of which 7 eyes were treated with antiglaucoma drugs and the intraocular pressure returned to normal within 2 weeks. One eye underwent trabeculectomy 1 month after operation, and the intraocular pressure was controlled. The progression of cataract was aggravated in 3 eyes. No retinal rebleeding, endophthalmitis and other complications were observed during follow-up. In the second part, the median of u-PA in TA group was 25.45ng/m Lnt-PA, the median of 127.44ng/m Ln PAI-1 was 0.42ng/m L. The content of vitreous u-PA in the group of 0.27ng/m L.TA was significantly higher than that in the group of 0.27ng/m L.TA, the difference was statistically significant (P < 0.05), but there was no significant difference in the contents of t-PA and PAI-1 in vitreous between TA group and control group (P < 0.05). Conclusion: intraocular injection of TA in vitrectomy can effectively control intraoperative retinal hemorrhage, shorten the operative time, and improve the safety of vitreous u-PA in patients with PDR, which may lead to intraocular hemorrhage. Intraocular application of TA in vitrectomy may reduce bleeding tendency by decreasing t-PA and u-PA levels, and achieve hemostatic effect by increasing PAI-1 level.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.6;R587.2

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相關期刊論文 前2條

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