本文選題：不同基質(zhì)眼膏 + 眼瞼和淚囊��； 參考：《鄭州大學(xué)》2010年碩士論文

【摘要】： 目的 眼膏常用于眼表、眼前節(jié)病變和眼科手術(shù)后,優(yōu)點是能維持結(jié)膜囊內(nèi)長時間有效的藥物濃度,減少用藥次數(shù),防治藥物流失。近年來,文獻(xiàn)中諸多報道淚道探通或激光疏通術(shù)后,注入眼膏以防止淚道再次粘連,可起到良好的軟性支撐作用。但在臨床工作中也見到一些患者,眼膏通過假道進(jìn)入淚囊周圍和眼瞼組織,進(jìn)而在眶組織內(nèi)降解吸收,引起嚴(yán)重的炎癥反應(yīng),且治療困難。 本實驗?zāi)康模河^察外用眼膏進(jìn)入眼瞼和淚囊周圍組織內(nèi)的不良反應(yīng)情況；進(jìn)而尋求有效地治療方法。為由于眼膏進(jìn)入眼部組織內(nèi)造成的炎癥反應(yīng)的治療提供實驗依據(jù)。第一部分：使用以凡士林和羊毛脂為基質(zhì)的紅霉素眼膏、以玻璃酸鈉為基質(zhì)的氧氟沙星眼膏,以及甲基纖維素,分別注射到豚鼠眼瞼皮下和淚囊周圍,建立動物模型,觀察和比較不同基質(zhì)眼膏在豚鼠眼瞼皮下、淚囊周圍的不良反應(yīng)；第二部分：篩選眼膏進(jìn)入眼瞼周圍組織內(nèi)的有效治療方法。材料與方法 動物與分組選用出生兩周齡的健康清潔級豚鼠72只(鄭州大學(xué)實驗動物中心提供),雌雄不限,年齡2～4周,體重120g～150g,排除各種眼科疾患。眼周為白色為宜,以便于大體觀察。隨機(jī)分為A、B、C組,每組24只。 動物模型制作動物以速眠新0.1ml/kg進(jìn)行腹腔麻醉。剪去下眼瞼及周圍毛發(fā),暴露皮膚,吉爾碘消毒。在顯微鏡下下瞼緣下3mm進(jìn)注射液深度2mm。A組右眼瞼輪匝肌及淚囊周圍注射以凡士林和羊毛脂為基質(zhì)的紅霉素眼膏0.5ml,B組右眼瞼輪匝肌及淚囊周圍注射以玻璃酸鈉為基質(zhì)的氧氟沙星眼膏0.5ml,C組作為對照組右眼瞼輪匝肌及淚囊周圍注射甲基纖維素0.5ml。0.5ml的藥物劑量可在下瞼形成直徑約15mm的皮丘。 觀察項目與時間點分別在注射后1天、3天、7天、14天、21天、28天六個時間點進(jìn)行觀察。觀察1、3、7天的充血腫脹程度,直徑小于10mm為Ⅰ紅腫,10～15mm為Ⅱ°紅腫,大于15mm以上為Ⅲ°紅腫；六個時間點的局部結(jié)節(jié)形成情況和眼膏降解吸收情況,取組織標(biāo)本做切片HE染色,觀察各時間點的局部組織病理學(xué)變化。 統(tǒng)計學(xué)分析處理應(yīng)用SPSS10.0統(tǒng)計軟件包,三組間紅腫腫脹程度的有序變量資料比較采用秩和檢驗,結(jié)節(jié)形成情況和眼膏降解吸收情況的計量資料比較采用單因素方差分析。結(jié)果 炎癥反應(yīng)情況A組：第1天可見嚴(yán)重的炎癥反應(yīng),均為Ⅲ°紅腫,甚至壞死形成潰瘍；第3天充血腫脹減輕,Ⅲ°紅腫仍有17眼；7天16只眼為Ⅰ°紅腫。B組：第1天充血腫脹,23眼為Ⅱ°紅腫,1眼為Ⅰ°紅腫；3天后消退。C組第1天24眼均為Ⅰ°紅腫,3天后完全消退。A組各時間點與B組、C組比較,差異有統(tǒng)計學(xué)意義(P＜0.05)。 局部結(jié)節(jié)形成情況A組：第1天結(jié)節(jié)形成明顯,隨時間直徑逐漸縮小,但持續(xù)觀察28天仍不見消退。B組：1天可見結(jié)節(jié),3天消退。C組第1天沒有有結(jié)節(jié)形成。A組各時間結(jié)節(jié)直徑與B組、C組比較,差異有統(tǒng)計學(xué)意義(P＜0.05)。 眼膏降解吸收情況A組第1天切開皮膚后可見降解吸收不明顯,大于注射時15mm,7天后逐漸被纖維組織包裹。B組第1天,直徑小于注射時的15mm,3天后全部吸收。C組第1天全部吸收。A組各時間點與B組、C組比較,眼膏的降解吸收吸收差異有統(tǒng)計學(xué)意義(P＜0.05)。 組織病理改變A組以羊毛脂和凡士林為基質(zhì)的眼膏進(jìn)入組織后,組織病理學(xué)可見炎癥反應(yīng)劇烈,早期以中性粒細(xì)胞為主的各種炎癥細(xì)胞浸潤,中晚期淋巴細(xì)胞和異物巨細(xì)胞增多,纖維組織增生,眼膏降解吸收緩慢。B組以玻璃酸鈉為基質(zhì)的眼膏進(jìn)入組織后組織反應(yīng)輕,早期少量炎癥細(xì)胞浸潤,3天后降解吸收,未見明顯的纖維組織增生。C組甲基纖維素注入組織后,僅少量炎癥細(xì)胞浸潤,3天組織結(jié)構(gòu)恢復(fù)正常。結(jié)論 以羊毛脂和凡士林為基質(zhì)的眼膏進(jìn)入眼瞼和淚囊周圍組織中,將引起嚴(yán)重的組織炎癥反應(yīng),可有纖維包裹形成,但降解吸收極慢,需積極給予治療。 以玻璃酸鈉為基質(zhì)的眼膏僅引起輕度組織炎癥反應(yīng),3天左右降解吸收,無明顯增生病變。無需特殊治療。 甲基纖維素組的組織反應(yīng)輕微,24小時可降解吸收,無明顯炎癥。無需治療。材料與方法 動物與分組健康清潔級豚鼠48只,4周齡,隨機(jī)分為A、B、C三組,每組16只。 動物模型制作動物以速眠新0.1ml/kg進(jìn)行腹腔麻醉。剪去下眼瞼及周圍毛發(fā),暴露皮膚,吉爾碘消毒。在各組豚鼠右眼瞼輪匝肌及淚囊周圍注射以凡士林和羊毛脂為基質(zhì)的紅霉素眼膏0.5ml。在下瞼形成直徑15mm皮丘。 治療方法A組于注射后24小時局部注射地塞米松5mg和慶大霉素注射液4萬單位共2ml；B組注射后24小時局部切開清除眼膏后生理鹽水沖洗；C組注射后24小時局部切開清除眼膏加生理鹽水沖洗后,局部注射地塞米松5mg和慶大霉素注射液4萬單位共2ml。 觀察項目與時間點觀察治療后1、3、7天觀察充血腫脹情況,直徑小于10mm為Ⅰ°紅腫,10～15mm為Ⅱ°紅腫,大于15mm以上為Ⅲ°紅腫；1、3、7、14天結(jié)節(jié)形成情況。A、B、C三組各時間點隨機(jī)處死四只豚鼠,取組織標(biāo)本做切片HE染色,觀察各時間點的局部組織病理學(xué)變化。 統(tǒng)計學(xué)分析處理應(yīng)用SPSS10.0統(tǒng)計軟件包,三組間充血腫脹況的有序變量資料采用秩和檢驗,結(jié)節(jié)形成情況的計量資料采用單因素方差分析。取α=0.05為檢驗水準(zhǔn)。結(jié)果 三組充血腫脹比較A組第1天14眼為Ⅲ°紅腫。第3天充血紅腫減輕,Ⅲ°紅腫仍有9眼,7天8只眼均為Ⅰ°紅腫。B第1天充血腫脹,15眼為Ⅲ°紅腫,1眼Ⅱ°紅腫,7天8只眼均為Ⅰ°紅腫。C組第1天13眼為Ⅲ°紅腫,3天5只眼Ⅱ°紅腫,7天紅腫消退。C組第七天與其他兩組比較有統(tǒng)計學(xué)意義(P＜0.05)。 三組結(jié)節(jié)形成情況比較A、B、C三組各時間點均有明顯的結(jié)節(jié)形成,隨觀察時間點消退不明顯。三組各時間點比較無統(tǒng)計學(xué)意義(P0.05)。 組織病理學(xué)A組炎癥細(xì)胞浸潤,眼膏不能吸收,炎癥反應(yīng)和纖維組織增生仍然明顯。B組組織內(nèi)未見眼膏,仍有明顯的炎癥細(xì)胞浸潤和纖維組織形成。C組未見眼膏殘留,炎癥細(xì)胞浸潤少,恢復(fù)快,但纖維組織增生明顯,局部形成瘢痕。結(jié)論 以羊毛脂和凡士林為基質(zhì)的眼膏進(jìn)入眼瞼和淚囊周圍組織后,采用局部切開清除眼膏,生理鹽水沖洗后,再局部注射地塞米松和慶大霉素,是效果最好的治療方法。
[Abstract]:objective
Eye ointment is often used in ocular surface, anterior segment lesion and eye surgery. The advantage is to maintain a long and effective drug concentration in the conjunctival capsule, reduce the number of drugs and prevent the loss of drugs. In recent years, many reports have reported that after lacrimal passage exploration or laser dredging, the eye ointment is injected to prevent the re adhesion of lacrimal duct, and it can play a good soft support. But in clinical work, some patients are also seen. Eye ointment enters the lacrimal sac and eyelid tissue through a false path, and then degrades and absorbs in the orbital tissue and causes severe inflammatory reactions, and the treatment is difficult.
Objective: To observe the adverse reaction of the external eye ointment into the eyelid and the surrounding tissue of the lacrimal sac, and to seek effective treatment. The first part: the use of Erythromycin Eye Ointment with vaseline and sheep hair fat as the basis for the treatment of the eye ointment. Sodium acid - based Ofloxacin Eye Ointment, and methyl cellulose, were injected into the subcutaneous and lacrimal sac of the guinea pig's eyelids, and animal models were established to observe and compare the adverse reactions of different matrix eye ointments in guinea pig eyelids and around the lacrimal sac. The second part: the effective treatment method of screening eye ointment into the surrounding eyelid tissue. Method
Animals and groups selected 72 healthy and clean grade guinea pigs of two weeks of age (provided by experimental animal center of Zhengzhou University), male and female, age 2~4 weeks, weight 120g to 150g, excluding all kinds of ophthalmological disorders. The eye week is white, which is convenient for general observation. It is randomly divided into A, B, C group, 24 rats in each group.
Animal model animals made abdominal anesthesia with fast sleeping 0.1ml/kg. Cut off the lower eyelids and the surrounding hair, expose the skin, and disinfect Gil iodine. In the lower lid edge of the lower eyelid, 3mm injection deep 2mm.A group and the right eyelid muscle and the lacrimal sac were injected with vaseline and lanolin as the matrix of Erythromycin Eye Ointment 0.5ml, B group right eyelid muscle And the injection of sodium hyaluronate as the matrix of Ofloxacin Eye Ointment 0.5ml around the lacrimal sac, group C as the control group the dose of the right eye palpebral orbicularis muscle and the injection of methyl cellulose 0.5ml.0.5ml around the dacryocyst could form the lower eyelid with a diameter of about 15mm in the lower eyelid.
Observation items and time points were observed at 1 days, 3 days, 7 days, 14 days, 21 days, 28 days, and six time points were observed. The degree of congestion and swelling of 1,3,7 days was observed, the diameter was less than 10mm I red swelling, 10 to 15mm was second degree red and swollen, more than 15mm was third degree red and swelling, the formation of local nodules and the degradation and absorption of eye ointment at six time points were taken. Tissue specimens were stained with HE staining to observe the local histopathological changes at different time points.
SPSS10.0 statistical software package was used for statistical analysis. The rank sum test of the swelling degree of the three groups was compared with the rank sum test, the formation of nodules and the measurement data of the degradation and absorption of eye ointment were compared by single factor analysis of variance.
Inflammatory response group A: first days of severe inflammatory reaction, all were III degree red swelling, and even necrosis formed ulcers; third days, congestion and swelling were alleviated, 17 eyes were red and swollen in 7 days, 16 eyes were I degree red and swollen.B group, 23 eyes were second degree red swelling, 1 eyes were I degree red swelling, and 3 days after first days of first days and first eyes were I degree red swelling, After 3 days, the.A group disappeared completely. Compared with group B and group C, the difference was statistically significant (P < 0.05).
The formation of local nodules in group A: first days of nodule formation was obvious, with time diameter gradually narrowing, but continued observation for 28 days was still not seen in group.B: 1 days of nodules were seen, and 3 days of regression of.C group had no nodular formation in group.A with B group, and C group compared with group C (P < 0.05).
The degradation and absorption of eye ointment in the A group was not obvious after first days of incision of the skin, which was more than 15mm at the time of injection. After 7 days, the.B group was gradually wrapped by fibrous tissue for first days, the diameter was less than the 15mm at the injection, and all of the.C groups absorbed all the.A group for first days after 3 days, and all the time points of the group of.A were compared with the B group. The difference of the degradation absorption and absorption of the eye ointment was statistically significant compared with that of the C group. Significance (P < 0.05).
Histopathological changes in A group with Lanolin and vaseline based ointment entered the tissue, histopathology showed severe inflammatory reaction, early neutrophil based inflammatory cells, intermediate and advanced lymphocyte and foreign body giant cells, fibrous tissue hyperplasia, and slow.B group with sodium hyaluronate as matrix. After the eye ointment entered the tissue, the tissue reaction was light and a small amount of inflammatory cells were infiltrated in the early stage. After 3 days, the tissue was degraded and absorbed. No obvious fibrous hyperplasia.C group was injected into the tissue, only a small amount of inflammatory cells were infiltrated, and the histological structure returned to normal on the 3 day.
The eye ointment based on lanolin and vaseline into the eyelid and the surrounding tissue of the lacrimal sac will cause serious tissue inflammation and can be formed by fibrous encapsulation, but the degradation and absorption are very slow and need to be treated actively.
The ointment made of sodium hyaluronate only caused mild tissue inflammatory reaction, and absorbed and absorbed 3 days. There was no obvious hyperplasia. No special treatment was needed.
The methylcellulose group had mild tissue reaction and could be absorbed and absorbed for 24 hours without obvious inflammation. No need for treatment. Materials and methods.
48 healthy and clean guinea pigs, 4 weeks old, were randomly divided into A, B and C three groups, 16 in each group.
Animal model animals were anesthetized with fast sleeping 0.1ml/kg. Cut off the lower eyelids and the surrounding hair, expose the skin, and disinfect Gil iodine. In each group of guinea pigs, the right eyelid muscles and lacrimal sac were injected with vaseline and lanolin as the matrix of Erythromycin Eye Ointment 0.5ml. in the lower eyelid diameter 15mm mound.
In group A, 24 hours after injection of dexamethasone 5mg and 40 thousand units of gentamicin injection, 40 thousand units of 2ml were injected, and group B was partially cut to clear the eye ointment after 24 hours of injection, and the local incision of eye ointment and saline irrigation after injection of C after injection in group C, local injection of dexamethasone 5mg and gentamicin injection 4 Ten thousand units 2ml.
Observation items and time point observation after 1,3,7 days after 1,3,7 days to observe the congestion and swelling, diameter less than 10mm is I degree red swelling, 10 to 15mm is second degree red swelling, more than 15mm is third degree red swelling, 1,3,7,14 day nodule formation of.A, B, C three groups at random to kill four guinea pigs, biopsy specimens for HE staining, observe the local point of the local point Histopathological changes.
SPSS10.0 statistical software package was used for statistical analysis. The ordered variable data of three groups of hematoma expansion were tested by rank sum test. The measurement data of nodular formation were analyzed by single factor variance. The results of alpha =0.05 were tested.
The swelling and swelling of the three groups in the first days of the three groups was III degree red and swelling, third days of red swelling and swelling were alleviated, 9 eyes were red and swollen in third days, 8 eyes were red swelling, first days, 15 eyes were red swelling, 1 eyes were red and swollen in 1 eyes, and 14 eyes in group I was I degree red and swollen on the 7 days in group I of.C There was a statistically significant difference between the two groups (P < 0.05).
The formation of three groups of nodules was compared with A, B, and C three groups with obvious nodule formation at each time point, and the regression was not obvious with the observation time point. There was no significant difference between the three groups at each time point (P0.05).
Histopathology A group inflammatory cell infiltration, eye ointment can not absorb, inflammatory reaction and fibrous tissue proliferation still obviously no eye ointment in group.B, still obvious inflammatory cell infiltration and fibrous tissue formation of.C group no eye ointment residue, inflammatory cell infiltration less, rapid recovery, but fibrous tissue hyperplasia, local scar formation.
After the eye ointment based on lanolin and vaseline enters the eyelid and the tissue around the lacrimal sac, the local incision is used to clear the eye ointment. After the saline irrigation, the local injection of dexamethasone and gentamicin is the best therapeutic method.
【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

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