本文選題：硅油　切入點(diǎn)：乳化　出處：《鄭州大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 眼科使用的硅油產(chǎn)品材料為聚二甲基硅氧烷(Polydimethylsiloxane,PDMS),基本分子單位是-(CH3)2-Si-O-,20℃時屈光指數(shù)1.404,與玻璃體的屈光指數(shù)1.336近似。硅油具有良好的光學(xué)透明性,疏水性,理化性能穩(wěn)定,毒性低,生理惰性和有效的表面張力,填充作用持久,能防止出血和纖維收縮等理化性質(zhì),已經(jīng)廣泛應(yīng)用于臨床治療多種復(fù)雜視網(wǎng)膜脫離,但同時其長期填充于眼內(nèi)帶來的多種并發(fā)癥嚴(yán)重影響手術(shù)后的遠(yuǎn)期療效,不容忽視。其中硅油乳化就是存在的比較嚴(yán)重的后期并發(fā)癥之一。 硅油乳化大多學(xué)者認(rèn)為是填充玻璃體腔內(nèi)的硅油大泡分離出穩(wěn)定不透明的硅油小泡,呈粉塵狀小滴貼附于眼內(nèi)組織或擴(kuò)散入眼周邊組織。乳化顆粒游動于玻璃體腔、前房或黏附在視網(wǎng)膜、虹膜表面,引起角膜、晶狀體病變或阻塞小梁網(wǎng)繼發(fā)青光眼或進(jìn)入眼周組織干擾眼生理引發(fā)一系列的并發(fā)癥。硅油乳化的發(fā)生原因至今難以定論,發(fā)生率約為0.7%～40%,是近些年困擾眼科臨床醫(yī)師的難題之一,國內(nèi)外對硅油乳化相關(guān)因素的基礎(chǔ)研究和臨床觀察也是近些年的熱門課題。 本實驗旨在體外研究分析手術(shù)過程中接觸到的臨床相關(guān)因素：平衡鹽溶液(balanced salt solution, BSS),曲安奈德,全氟萘烷,新鮮血清,以及長期飲酒患者血液中乙醇成分對硅油乳化的影響,建立有效的體外促乳化模型,為今后硅油乳化防治的深入研究和眼內(nèi)填充物性狀改善提供依據(jù)。 材料和方法 使用特制5ml容量瓶體外仿效人眼模型,于其中加入不同的干擾因素：純平衡鹽溶液0.5ml和硅油(法國Arciolane 5500cs)4.0ml配置作為對照組,曲安奈德、新鮮血清、全氟萘烷、無水乙醇的BSS的溶液各0.5ml和硅油4.0ml配置作為實驗組,在37℃置于恒溫氣浴搖床中,振蕩速度120轉(zhuǎn)/分,由一名非相關(guān)實驗人員在暗視野顯微鏡下觀察1周、2周、4周、8周每組硅油乳化情況并計數(shù)乳化顆粒數(shù)目。 結(jié)果 1.每個參與實驗的組在不同時間相比差異均是(p0.05),結(jié)果有統(tǒng)計學(xué)意義,表示隨時間延長乳化顆粒均有增加趨勢。 2.曲安奈德組與對照BSS組每個時間乳化顆粒數(shù)目相比,使用成組定量資料t檢驗結(jié)果均是(p0.05),結(jié)果有統(tǒng)計學(xué)意義,乳化硅油小滴數(shù)目有所減少。 3.全氟萘烷(重水)組與對照BSS組每個時間乳化顆粒數(shù)目相比,使用成組定量資料t檢驗結(jié)果均是(p0.05),結(jié)果有統(tǒng)計學(xué)意義,乳化硅油小滴數(shù)目有所增加。 4.新鮮血清組與對照BSS組在1W、2W、4W時間相比,使用成組定量資料t檢驗結(jié)果均是(p0.05),結(jié)果有統(tǒng)計學(xué)意義,乳化硅油小滴數(shù)目有所減少;8W分析結(jié)果是(t=-1.276,p0.05),結(jié)果沒有統(tǒng)計學(xué)意義,認(rèn)為8周曲安奈德組與BSS組乳化顆粒數(shù)目沒有差別。 5.無水乙醇組與對照BSS組在1W、2W、4W時間相比,使用成組定量資料t檢驗結(jié)果均是(p0.05),結(jié)果有統(tǒng)計學(xué)意義,乳化硅油小滴數(shù)目有所減少；8W時間統(tǒng)計(t=-14.586,p0.05),結(jié)果有統(tǒng)計學(xué)意義,認(rèn)為8W無水乙醇組比BSS組乳化顆粒數(shù)目多。 結(jié)論 1.成功建立眼模型體外實驗雖不能完全模擬體內(nèi)環(huán)境,但能統(tǒng)一眾多繁雜因素,分析手術(shù)相關(guān)接觸因素對硅油乳化的效能。 2.在臨床意義上完全避免接觸干擾因素是不可能的,全氟萘烷可能增加硅油乳化,故手術(shù)中盡量減少全氟萘烷應(yīng)用；手術(shù)過程中應(yīng)用曲安奈德,有可能減少硅油乳化的發(fā)生；血液成分、乙醇成分滲出玻璃體腔,可能影響手術(shù)后遠(yuǎn)期硅油乳化量,術(shù)中、術(shù)后應(yīng)控制出血、避免飲酒。
[Abstract]:Silicone products for ophthalmic use materials two polydimethylsiloxane (Polydimethylsiloxane, PDMS), the basic unit is the molecular - (CH3) 2-Si-O-, 20 DEG C when the refractive index of 1.404, and the refractive index of 1.336 vitreous body approximation. Silicone oil has good optical transparency, hydrophobicity, stable physicochemical properties, low toxicity, physiological inertia and effective surface tension, with lasting effect, can prevent bleeding and shrinkage and other physicochemical properties, has been widely used in clinical treatment of complicated retinal detachment, but its long-term complications in the eye filled with a variety of serious long-term effect, after the operation can not be ignored. One of the more serious complications of silicone oil emulsion is there.
Most scholars believe that the silicone oil emulsion is filled with intravitreal silicone oil bubble isolated opaque silicone oil vesicles are stable, dust like droplets attached to the intraocular tissue or surrounding tissues. Emulsion particles diffusion by swimming in the anterior chamber or vitreous cavity, the surface adhesion in the retina, iris, corneal lens, or obstruction of the trabecular meshwork secondary lesion glaucoma or enter the eye tissue interference eye physiological cause a series of complications. Causes of silicone oil emulsion has been difficult to determine, the incidence rate is about 0.7% ~ 40%, is one of the difficult problems in recent years by ophthalmic clinicians, hot topics of study abroad based on silicone oil emulsification related factors and clinical observation is also in recent years.
The purpose of this experiment was to study the in vitro clinical factors related to exposure during surgery: balanced salt solution (balanced salt, solution, BSS), triamcinolone acetonide, perfluorodecalin, fresh serum, and the long-term effects of drinking alcohol components in blood of silicone oil emulsion, establishing an effective in vitro model for the further study of emulsion. And intraocular silicone oil emulsification prevention filling characters provide a basis for improving.
Materials and methods
The use of special 5ml volumetric flask in vitro follow the human model, in which added different interference factors: pure balanced salt solution 0.5ml and silicone oil (French Arciolane 5500cs) 4.0mL configuration as control group, triamcinolone acetonide, fresh serum, perfluorodecalin solution, ethanol BSS 0.5ml 4.0mL configuration and silicone oil as the experimental group, in 37 C in a constant temperature air bath shaker, oscillation speed of 120 rpm, by a non experimental personnel in the dark field microscopy observation of 1 weeks, 2 weeks, 4 weeks, 8 weeks the number of silicone oil emulsion and emulsion particle counting.
Result
1. the differences in each group were (P0.05) at different times, and the results were statistically significant, indicating that the emulsified particles increased with time.
2. triamcinolone acetonide group compared with the control group BSS, the number of each time of emulsion particles, using a group of quantitative data t test results are (P0.05), the results were statistically significant, the number of emulsified silicone oil droplets decreased.
3. perfluorodecalin (D2O) group compared with the control group each time the number of BSS emulsion particles, using a group of quantitative data t test results are (P0.05), the results were statistically significant, increase in the number of vesicles of emulsified silicone oil.
4. fresh serum group and control group BSS in 1W, 2W, 4W time compared to the use of group T results are quantitative data (P0.05), the results were statistically significant, the number of emulsified silicone oil droplets decreased; the results of 8W analysis is (t=-1.276, P0.05), the results were not statistically significant, that there is no difference between the number of 8 weeks of triamcinolone acetonide group BSS and group of emulsion particles.
The 5. ethanol group and control group BSS in 1W, 2W, 4W time compared to the use of group T results are quantitative data (P0.05), the results were statistically significant, emulsified silicone oil droplets number decreased; 8W time statistics (t=-14.586, P0.05), the results were statistically significant, as 8W ethanol group than in the BSS group number of emulsion particles.
conclusion
1. the successful establishment of eye model in vitro can not simulate the internal environment completely, but it can unify many complicated factors, and analyze the effect of surgical related factors on the emulsification of silicone oil.
2. in the clinical sense to completely avoid exposure to interference factors is not possible, perfluorodecalin may increase the emulsification of the silicone oil the surgery to minimize perfluorodecalin application; the application of Cu Ann Ned during the surgery, may reduce the occurrence of silicone oil emulsion; blood components, components of alcohol may affect the exudation of the vitreous surgery after long-term silicone oil the amount of emulsion, intraoperative, postoperative bleeding should be controlled, to avoid alcohol.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R779.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李文化,Zazimul Hussian Taratrasad Das Ajit B Majji Subhadra Jalali;超聲生物顯微鏡在硅油填充眼中的應(yīng)用[J];國際眼科雜志;2003年02期

2 張雁冰;成霄黎;董靜;;二次玻璃體腔注射曲安奈德治療糖尿病性黃斑水腫[J];國際眼科雜志;2005年06期

3 楊磊;鐘元元;周和政;;硅油填充眼的白內(nèi)障超聲乳化術(shù)[J];國際眼科雜志;2006年04期

4 馬麗娜;惠延年;王雨生;張樂;王靜波;徐建峰;馬吉獻(xiàn);;硅油小滴對人視網(wǎng)膜色素上皮細(xì)胞吞噬活性的影響[J];國際眼科雜志;2007年02期

5 范傳峰;王玉;季強(qiáng);譚瑞禮;;硅油取出術(shù)后高眼壓的轉(zhuǎn)歸[J];國際眼科雜志;2009年03期

6 朱宇東;臧晶;周斌兵;李青;鮑炯琳;林文雄;;硅油填充術(shù)后繼發(fā)青光眼的臨床分析[J];國際眼科雜志;2009年09期

7 段欣榮,劉武;眼內(nèi)硅油并發(fā)癥的研究進(jìn)展[J];國外醫(yī)學(xué).眼科學(xué)分冊;1997年05期

8 葉宇峰;硅油填充引發(fā)的角膜病變[J];國外醫(yī)學(xué).眼科學(xué)分冊;2002年04期

9 徐鼎;董方田;;硅油眼內(nèi)填充后的并發(fā)癥[J];國際眼科縱覽;2006年02期

10 史季桐;硅油取出的并發(fā)癥和時機(jī)[J];國外醫(yī)學(xué).眼科學(xué)分冊;1995年04期

相關(guān)博士學(xué)位論文 前1條

1 安建斌;姜黃素防治增殖性玻璃體視網(wǎng)膜病變的實驗研究[D];河北醫(yī)科大學(xué);2009年

，

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