【摘要】：眼外傷是重要的公共健康問題,對個人以及社會造成不良的后果[1]。開放性眼外傷是一種全層眼球壁連續(xù)性遭到破壞的一種類型的眼外傷,其損傷具有多樣性、個體差異性、預(yù)后較差、治療棘手[2]等特點。針對不同的外傷類型,治療的手段、方法不盡相同,根據(jù)國際眼外傷學(xué)會的分類、分區(qū)標(biāo)準,我們將主要的研究內(nèi)容放在嚴重開放性眼外傷手術(shù)時機的探討上。目的:本研究通過對兩類眼外傷病人的隨訪觀察,探討手術(shù)時間對其安全性及預(yù)后的影響。方法:本文分為兩個部分:第一部分主要納入的是排除球內(nèi)異物和眼內(nèi)炎的嚴重開放性眼外傷病人,通過對急診48h內(nèi)介入玻璃體手術(shù)和7~28天手術(shù)的療效觀察,評估急診48h內(nèi)行玻璃體手術(shù)的可行性及安全性。第二部分主要通過對伴有球內(nèi)異物的眼外傷病人的不同手術(shù)時機的觀察,評估在該類病人中兩種不同的玻璃體手術(shù)時間的預(yù)后差異,以期為該類病人在臨床手術(shù)時間的選擇上提供依據(jù)。結(jié)果:第一部分:(1)目前納入的研究病例顯示:急診48h內(nèi)玻璃體手術(shù)與傷后7~28d手術(shù)在術(shù)前損傷差異、術(shù)后一次性視網(wǎng)膜復(fù)位、TPVR、眼球保存率、視力、眼壓控制等情況的比較差異無統(tǒng)計學(xué)意義。(2)由于目前納入的病例數(shù)較少,因此對于嚴重開放性眼外傷病人,早期48h內(nèi)介入玻璃體手術(shù)對病人的安全性尚待進一步研究。第二部分:(1)球內(nèi)異物病人中延遲玻璃體手術(shù)會增加其并發(fā)眼內(nèi)炎的風(fēng)險,24h內(nèi)行PPV與24~48h行PPV比較,后者的眼內(nèi)炎發(fā)生率明顯高于前者。(2)盡早行玻璃體手術(shù)是治療球內(nèi)異物的開放性眼外傷安全、有效的手段。結(jié)論:對于伴有球內(nèi)異物的開放性眼外傷病人,為了防止其眼內(nèi)炎的發(fā)生,應(yīng)盡可能的早期進行玻璃體手術(shù)。而不伴有球內(nèi)異物或眼內(nèi)炎的嚴重開放性眼外傷,因目前納入的病例數(shù)少,故急診48小時內(nèi)行PPV的安全性尚待進一步研究。
[Abstract]:Eye trauma is an important public health problem, with adverse consequences for individuals and society. Open ocular trauma is a kind of ocular trauma which is damaged by the continuity of the whole eyeball wall. Its injury has the characteristics of diversity, individual difference, poor prognosis, difficult treatment and so on. According to the classification and zoning standard of the International Academy of Ocular Trauma, we put the main research contents on the discussion of the operative opportunity of severe open ocular trauma. Objective: to investigate the effect of operation time on the safety and prognosis of two kinds of ocular trauma patients. Methods: this article was divided into two parts: the first part mainly included the patients with severe open ocular trauma who excluded intraocular foreign bodies and endophthalmitis. The curative effect of interventional vitreous surgery and 728 days operation were observed. To evaluate the feasibility and safety of emergency vitrectomy within 48 hours. The second part is to evaluate the prognosis of two kinds of vitreous surgery in patients with ocular trauma with intraocular foreign bodies. In order to provide the basis for the choice of clinical operation time for this kind of patients. Results: the first part: (1) the results of the present study showed that the difference between vitreous surgery and operation 728 days after injury, retinal reattachment after operation, TPVR, eyeball preservation rate, visual acuity. There was no significant difference in intraocular pressure control. (2) because of the small number of cases, the safety of vitreous intervention in patients with severe open ocular trauma remains to be further studied within 48 hours. Part two: (1) delayed vitreous surgery increased the risk of endophthalmitis in patients with intraocular foreign body. The risk of intraocular inflammation was increased by PPV within 24 hours and PPV at 24 and 48 hours, respectively. The incidence of endophthalmitis in the latter was significantly higher than that in the former. (2) early vitrectomy is a safe and effective method for the treatment of open ocular trauma of intraocular foreign bodies. Conclusion: vitreous surgery should be performed as early as possible to prevent endophthalmitis in patients with open ocular trauma with intraocular foreign bodies. However, the safety of PPV in emergency department within 48 hours remains to be further studied for the severe open ocular trauma without intraocular foreign body or endophthalmitis.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R779.6

【參考文獻】

相關(guān)期刊論文 前10條

1 段毅琴;林丁;陳忠平;王啟常;;眼內(nèi)注射萬古霉素對化膿性眼內(nèi)炎影響的臨床研究[J];國際眼科雜志;2015年05期

2 孫月明;張林;;眼內(nèi)異物46例療效回顧分析[J];國際眼科雜志;2014年10期

3 張凌;劉勇;陳少軍;王一;;開放性眼外傷不同時機玻璃體手術(shù)的對比觀察[J];中華眼科雜志;2014年02期

4 楊格強;熊全臣;王麗麗;;機械性眼外傷122例臨床特征及診療結(jié)果分析[J];國際眼科雜志;2013年09期

5 張保松;;復(fù)雜開放性眼外傷手術(shù)療效及其相關(guān)影響因素分析[J];眼科新進展;2012年12期

6 王啟常;周增超;;急診玻璃體手術(shù)治療眼后段異物傷的臨床觀察[J];國際眼科雜志;2011年11期

7 陳放;莊朝榮;趙明;葉東升;;玻璃體手術(shù)治療嚴重眼外傷影響治療效果因素分析[J];眼外傷職業(yè)眼病雜志(附眼科手術(shù));2009年05期

8 謝茂松;吳雅冰;徐國興;;GM 6001干預(yù)外傷性增生性玻璃體視網(wǎng)膜病變的病理形態(tài)學(xué)研究[J];國際眼科雜志;2009年01期

9 萬安云;彭渝;黃海;吳慧鶯;蘭緒達;;玻璃體手術(shù)治療嚴重眼外傷[J];國際眼科雜志;2008年01期

10 馬志中;我國機械性眼外傷防治的研究現(xiàn)狀與進展[J];中華眼科雜志;2005年08期

，

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