【摘要】：目的 通過觀察權(quán)身病與玻璃體手術(shù)治療的相互影響和處理措施,加強(qiáng)對(duì)全身病與玻璃體手術(shù)治療相互影響的認(rèn)識(shí),積極采取合理的處理措施,提高手術(shù)安全性,改善治療效果。 方法 對(duì)94例(103眼)合并全身病的玻璃體視網(wǎng)膜病變患者進(jìn)行臨床研究,其中男45例(48眼),女49例(55眼)。 術(shù)前詳細(xì)檢查患者全身情況,監(jiān)測(cè)并穩(wěn)定血糖、血壓等全身情況,觀察患者能否耐受玻璃體手術(shù)。對(duì)患者進(jìn)行詳細(xì)的術(shù)前談話,告知手術(shù)和全身病風(fēng)險(xiǎn)。 所有玻璃體手術(shù)均在局麻下進(jìn)行,術(shù)中根據(jù)具體情況聯(lián)合品狀體切除、視網(wǎng)膜前膜剝除、視網(wǎng)膜激光光凝、電凝、冷凝、眼內(nèi)填充等；需行硅油取出術(shù)的患者也在局麻下手術(shù),可根據(jù)情況聯(lián)合人工晶狀體植入等。術(shù)中均應(yīng)用心電監(jiān)護(hù)儀監(jiān)測(cè)患者全身情況。術(shù)前術(shù)后對(duì)患者眼部部情況進(jìn)行仔細(xì)的檢查,觀察并記錄患者手術(shù)前后視力情況,統(tǒng)計(jì)術(shù)中、術(shù)后全身病變化及處理措施。術(shù)后隨訪2月-1年,觀察隨訪時(shí)患者眼部及全身疾病情況。所有數(shù)據(jù)采用SPSS17.0軟件系統(tǒng)進(jìn)行分析。 結(jié)果 同期行玻璃體手術(shù)治療的玻璃體視網(wǎng)膜病變患者』共523例,其中合并全身病的89例,占17.0%。 94例合并全身病的玻璃體視網(wǎng)膜病變患者中,89例(94.7%)順利完成玻璃體手術(shù)治療,5例(5.3%)因患者全身情況不能耐受手術(shù),未予手術(shù)治療。 89例(98眼)行玻璃體手術(shù)治療的合并全身病的玻璃體視網(wǎng)膜病變患者中,3眼(3.1%)選擇填充重硅油。41例(46.1%)術(shù)后全身應(yīng)用皮質(zhì)類固醇激索,48例(53.9%)因糖尿病等全身病原因術(shù)后未全身應(yīng)用皮質(zhì)類固醇激素；6例(6.7%)因糖尿病腎病圍手術(shù)期選擇應(yīng)用腎毒性小的抗生素。6眼(6.1%)硅油填充術(shù)后并發(fā)輕度真菌性角膜潰瘍。 行玻璃體手術(shù)治療的玻璃體視網(wǎng)膜病變患者中,合并全身病患者的年齡較未合并全身病患者大(P=0.000)。合并全身病患者(除外傷)的住院天數(shù)較未合并全身病患者(除外傷)長(zhǎng)(P=0.044)。 經(jīng)玻璃體手術(shù)治療,合并全身病的玻璃體視網(wǎng)膜病變患者的術(shù)后視力提高的有62眼(63.2%),視力不變的有23眼(23.5%),視力下降的有13眼(13.3%)。 術(shù)中4例(4.5%)心率加快,3例(3.4%)心率減緩,6例(6.7%)血壓升高。術(shù)后5例(5.6%)血壓升高,7例(7.9%)血糖升高,2例(2.2%)腎病加重。 結(jié)論 1、合并全身病患者在眼病患者中所占比例高,應(yīng)用玻璃體手術(shù)治療的比例亦高；部分全身病患者不能耐受或溝通后拒絕玻璃體手術(shù)治療；部分患者術(shù)中引起心率、血壓爪波動(dòng),手術(shù)應(yīng)激和圍手術(shù)期用藥引起血糖、血壓波動(dòng)、腎病加重等；全身真菌性疾病可增加眼部發(fā)生真菌感染的機(jī)率。 2、提高對(duì)全身病與玻璃體手術(shù)治療相互影響的認(rèn)識(shí)；術(shù)前全面評(píng)估全身病患者全身情況,調(diào)整全身病至穩(wěn)定狀態(tài),允分溝通告知全身病與手術(shù)風(fēng)險(xiǎn)：術(shù)中監(jiān)測(cè)全身情況并及時(shí)調(diào)整,選擇合適的眼內(nèi)填充物；圍手術(shù)期慎重選擇全身藥物；加強(qiáng)術(shù)后和出院指導(dǎo)。通過以上綜合措施,可提高手術(shù)安全性,改善治療效果。
[Abstract]:Purpose By observing the mutual influence and treatment measures of the right body disease and the vitreous surgery treatment, the mutual influence of the whole body disease and the vitreous surgery treatment is enhanced, reasonable treatment measures are taken, the operation safety is improved, and the treatment is improved. effect Methods 94 patients with vitreoretinopathy (103 eyes) with whole body disease were studied with clinical study, of which 45 (48 eyes), female, 49 cases (55 eyes). The whole body condition of the patient was examined in detail before the operation, and the whole body conditions such as blood sugar and blood pressure were monitored and stabilized. The patient was able to withstand the vitreous surgery. A detailed pre-operative conversation was performed on the patient, inform the operation and the whole body disease risk. All the vitreous surgery is performed under the local anesthesia, the operation is combined with the article-like body resection according to the specific conditions, the pre-retinal membrane stripping, the retinal laser photocoagulation, the electrocoagulation, the condensation, the in-eye filling and the like; and the silicon is required to be carried out. The patient who has been removed from the oil is also operated under the local anesthesia and may The combination of intraocular lens implantation and the like according to the condition. The general condition of the patient was monitored by an ECG monitor. The patient's eyes were examined carefully before and after the operation, and the vision and statistics before and after the operation of the patient were observed and recorded. The changes of the whole body's disease and its treatment after operation. Follow-up for 2 months to 1 year after operation. Patient's eye and body condition at follow-up. All data is SP SS A total of 523 patients with vitreoretinopathy treated with vitreoretinal surgery in the same period Of these, 89 (94.7%) of the 94 patients with whole body disease were treated with vitreoretinal surgery and 5 (5). 3% of patients with vitreoretinopathy treated with vitreoretinal surgery in 89 cases (98 eyes) were treated with vitreoretinal, 3 eyes (3.1%) were selected to be filled with heavy silicone oil. In 41 cases (46.1%), the whole body was treated with corticosteroids, 48 Corticosteroid hormone was not applied to the whole body due to general disease such as diabetes, 6 cases (60.7%) were used for the selection of antibiotics with small nephrotoxicity in the perioperative period of diabetic nephropathy.. 6 eyes (6. 1%) of silicone oil were filled with mild mycotic keratomy after operation. In the patients with vitreoretinopathy treated with vitreoretinal surgery, The age of the patients with the combination of the whole body was higher than that of the whole body (P = 0.000). The patients with the whole body (other than those with the exception of the injury) The number of days of hospital stay was longer than that of patients with whole body disease (other than injury) (P = 0.044). There were 23 eyes (23. 5%) with the same force and 13 eyes (1.3%) with a reduced vision. 4. 5%) heart rate was accelerated, 3 (3. 4%) heart rate decreased, 6 (6. 7%) blood pressure increased, and 5 cases (6. 7%). 5. Conclusion 1. The proportion of patients with whole body disease in the patients with eye disease is high, and the proportion of application of vitreoretinal surgery is high. Some of the patients with whole-body disease can't tolerate or communicate and reject the treatment of vitreous surgery; in some patients, the heart rate, the pressure of the blood pressure, the operation stress and the surrounding hand are caused by the operation of the patients. Intraoperative medication causes blood sugar, blood pressure fluctuation, and worsening of kidney disease, etc.; the fungal disease of the whole body can increase the probability of fungal infection in the eye; 2, raise the understanding of the interaction between the whole body disease and the vitreous surgery; and comprehensively assess the whole body's disease before the operation. The whole body condition is adjusted to the stable state, and the whole body is informed of the whole body disease and the operation risk through the communication. Intraoperative supervision To measure the whole body and adjust it in a timely manner, and select the appropriate intra-ocular filler;
【學(xué)位授予單位】：鄭州大學(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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