【摘要】：第一部分三種M受體阻滯劑對(duì)成年近視患者調(diào)節(jié)的影響 目的探討三種M受體阻滯劑對(duì)成年近視患者調(diào)節(jié)的影響。 方法自身對(duì)照研究。選取19名成年近視患者作為受試者,每位受試者分次滴2.5%潔霉素及三種M受體阻滯劑：1%鹽酸環(huán)噴托酯、0.05%消旋山莨菪堿、0.5%托吡卡胺,2.5%潔霉素作為對(duì)照,兩次用藥至少間隔4天作為藥物洗脫期。給藥方法：滴雙眼(先右眼后左眼,雙眼間隔5分鐘)；每只眼睛滴藥兩次,兩次滴藥間隔5分鐘,每次一滴。于滴藥前及滴藥后的10、20、30、45、60、75、90、120分鐘采用Topcon電腦驗(yàn)光儀在暗室內(nèi)測(cè)量藥物干預(yù)前后受試者的瞳孔直徑,在綜合驗(yàn)光儀上采用負(fù)鏡法測(cè)量藥物干預(yù)前后的受試者右眼的調(diào)節(jié)幅度。使用SAS9.2統(tǒng)計(jì)軟件對(duì)4種藥物干預(yù)后的瞳孔直徑及調(diào)節(jié)幅度進(jìn)行方差分析,對(duì)1%鹽酸環(huán)噴托酯及0.5%托吡卡胺干預(yù)后的最小調(diào)節(jié)幅度進(jìn)行t檢驗(yàn),對(duì)0.05%消旋山莨菪堿及2.5%潔霉素干預(yù)后的最小調(diào)節(jié)幅度進(jìn)行t檢驗(yàn)。P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果1、散瞳作用：滴用1%鹽酸環(huán)噴托酯滴眼液及0.5%托吡卡胺滴眼液后120分鐘瞳孔散至最大,與給藥前相比瞳孔直徑分別增大(1.34±0.81)mm及(1.59±0.89)mm,滴用0.05%消旋山莨菪堿滴眼液10分鐘后瞳孔直徑縮小,45分鐘后瞳孔開始散大,120分鐘后散至最大,與給藥前相比瞳孑孔直徑增大(0.63±0.30)mm,滴用2.5%潔霉素后瞳孔直徑較給藥前縮小,滴藥后10分鐘瞳孔直徑最小較給藥前縮小(0.27±0.15)mm,方差分析4種藥物干預(yù)后不同時(shí)間點(diǎn)的瞳孔直徑發(fā)現(xiàn)4種藥物之間差別具有統(tǒng)計(jì)學(xué)意義(P0.05)。2、睫狀肌麻痹作用：1%鹽酸環(huán)噴托酯滴眼液干預(yù)后10分鐘開始起效,60分鐘調(diào)節(jié)幅度為(2.01±1.20)D,120分鐘調(diào)節(jié)幅度最小為(1.67±0.85)D, 0.5%托吡卡胺滴眼液干預(yù)后10分鐘開始起效,30分鐘調(diào)節(jié)幅度最小為(1.94±0.72)D,60分鐘調(diào)節(jié)幅度為(2.05±0.70)D,睫狀肌麻痹作用開始減弱,120分鐘調(diào)節(jié)幅度為(3.75±1.52)D,t檢驗(yàn)分析干預(yù)后的最小調(diào)節(jié)幅度2種藥物之間差別無統(tǒng)計(jì)學(xué)意義。0.05%消旋山莨菪堿滴眼液干預(yù)后的最小調(diào)節(jié)幅度為(9.48±2.21)D,2.5%潔霉素眼液干預(yù)后的最小調(diào)節(jié)幅度為(9.56±3.28)D,t檢驗(yàn)分析干預(yù)后的最小調(diào)節(jié)幅度2種藥物之間差別無統(tǒng)計(jì)學(xué)意義。 結(jié)論1.1%鹽酸環(huán)噴托酯滴眼液對(duì)于成年近視患者的睫狀肌麻痹效果并不明顯優(yōu)于0.5%托吡卡胺,但其睫狀肌麻痹作用持續(xù)時(shí)間較長(zhǎng),適用于等待時(shí)間超過1小時(shí)的近視患者睫狀肌麻痹驗(yàn)光。2.0.05%消旋山莨菪堿滴眼液有散瞳作用,無明顯的睫狀肌麻痹作用。 第二部分三種M受體阻滯劑對(duì)成年近視患者像差的影響 目的探討三種M受體阻滯劑對(duì)成年近視患者像差的影響。 方法自身對(duì)照研究。選取12名成年近視患者作為受試者,每位受試者分次滴2.5%潔霉素及三種M受體阻滯劑：1%鹽酸環(huán)噴托酯、0.05%消旋山莨菪堿、0.5%托吡卡胺,2.5%潔霉素作為對(duì)照,兩次用藥至少間隔4天作為藥物洗脫期。給藥方法：滴雙眼(先右眼后左眼,雙眼間隔5分鐘)；每只眼睛滴藥兩次,兩次滴藥間隔5分鐘,每次一滴。于滴藥前及滴藥后的30分鐘應(yīng)用Schwind波前像差儀檢查藥物干預(yù)眼的全眼像差,提取瞳孔分析直徑4.0mm、5.0mm、6.0mm時(shí)的像差值,比較4種藥物干預(yù)前后及4種藥物之間在總像差(RMSg)、總高階像差(RMSh)、3階、4階像差的均方根(RMS)值及球差、彗差等方面的差異。采用SAS 9.2統(tǒng)計(jì)分析軟件對(duì)數(shù)據(jù)進(jìn)行方差分析。P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果1、隨著瞳孔分析直徑增大,總像差(RMSg)、總高階像差(RMSh)、3階、4階像差的均方根(RMS),彗差,球差均增加,方差分析發(fā)現(xiàn)除潔霉素干預(yù)后的球差外其余各項(xiàng)像差值的差別具有統(tǒng)計(jì)學(xué)意義(P0.05)。2、瞳孔分析直徑為6mm時(shí),藥物干預(yù)前球差為(0.07±0.11)u m,1%鹽酸環(huán)噴托酯干預(yù)后、0.5%托吡卡胺干預(yù)后、0.05%消旋由莨菪干預(yù)后及2.5%潔霉素干預(yù)黃后球差分別為(0.10±0.10)μm、(0.08±0.11)u m、(0.07±0.12)μm、(0.05±0.12)μm,1%鹽酸環(huán)噴托酯及0.5%托吡卡胺藥物干預(yù)后球差向正向方向增大,0.05%消旋山莨菪堿干預(yù)后球差無明顯變化,方差分析比較藥物干預(yù)前及4種藥物干預(yù)后的球差顯示差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論成年近視患者準(zhǔn)分子激光術(shù)術(shù)前應(yīng)用1%鹽酸環(huán)噴托酯眼液或0.5%托吡卡胺眼液散瞳時(shí),應(yīng)注意其對(duì)像差特別是球差的影響。
[Abstract]:Part 1 the effects of three M receptor blockers on the regulation of adult myopia
Objective to investigate the effects of three M receptor blockers on the regulation of adult myopia.
Methods A self-controlled study was conducted in 19 adult myopic patients. Each subject was given 2.5% lincomycin and three M-receptor blockers: 1% cyclopentolate hydrochloride, 0.05% racemic anisodamine, 0.5% topicamide, and 2.5% lincomycin at least 4 days intervals for elution. The pupil diameter of the subjects before and after the drug intervention was measured by Topcon computer refractometer in the darkroom, and the pupil diameter of the subjects before and after the drug intervention was measured by negative lens on the comprehensive refractometer. Adjustment amplitude of right eye was measured before and after intervention. The pupil diameter and adjustment amplitude were analyzed by SAS 9.2 statistical software. The minimum adjustment amplitude after 1% cyclopentolate hydrochloride and 0.5% topicamide intervention was tested by t test. The minimum adjustment amplitude after 0.05% anisodamine and 2.5% lincomycin intervention was tested. .P0.05 was statistically significant in t test.
Result 1. Mydriasis: After 1% cyclopentolate hydrochloride eye drops and 0.5% topicamide eye drops, the pupil size was maximal at 120 minutes. Compared with before administration, the pupil diameter was increased by (1.34 0.81) mm and (1.59 0.89) mm respectively. After 10 minutes, the pupil diameter of 0.05% racemic Anisodamine Eye Drops decreased, and after 45 minutes, the pupil began to dilate, and at 120 minutes, respectively. The pupil diameter increased (0.63 (P 0.05).2, ciliary muscle paralysis: 1% cyclopentolate hydrochloride eye drops began to take effect 10 minutes after intervention, the regulation range of 60 minutes was (2.01 (1.20) D, the regulation range of 120 minutes was (1.67 (0.85) D, 0.5% tropicamide eye drops began to take effect 10 minutes after intervention, the regulation range of 30 minutes was (1.94 (0.72) D, and the regulation range of 60 minutes was (1.94 (0.72) D). (2.05 [0.70] D, the effect of ciliary paralysis began to weaken, the regulatory range of 120 minutes was (3.75 [1.52] D, t test analysis showed that there was no significant difference between the minimum regulatory range after intervention between the two drugs. T test showed that there was no significant difference between the two drugs in the minimum amplitude of regulation after intervention.
Conclusion 1.1% cyclopentolate hydrochloride eye drops are not superior to 0.5% tropicamide in the treatment of adult myopic patients with ciliary muscle paralysis, but the effect of cyclopentolate hydrochloride eye drops on ciliary muscle paralysis lasts longer. 2.0.05% racemic Anisodamine Eye Drops are suitable for myopic patients with ciliary muscle paralysis who wait longer than 1 hour. Ciliary paralysis.
The second part: the influence of three M blockers on the aberrations of adult myopia patients.
Objective to investigate the effects of three M receptor blockers on aberrations in adult myopia patients.
Methods A self-controlled study was conducted in 12 adult myopic patients. Each subject was given 2.5% lincomycin and three M-receptor blockers: 1% cyclopentolate hydrochloride, 0.05% racemic anisodamine, 0.5% topicamide and 2.5% lincomycin at least 4 days intervals for elution. The whole eye aberrations of the drug-treated eyes were examined by Schwind wavefront aberration meter before and 30 minutes after the drug-treated eyes were dripped, and the aberrations of the pupils with diameters of 4.0mm, 5.0mm and 6.0mm were extracted and analyzed. Differences in total aberration (RMSg), total higher order aberration (RMSh), root mean square (RMS) values of third and fourth order aberrations, spherical aberration, coma, etc. were analyzed by statistical analysis software SAS 9.2. There was statistical significance in P 0.05.
Results 1. With the increase of pupil diameter, RMSg, RMSh, RMS, coma and spherical aberration, the difference of all the aberrations except for the spherical aberration after the intervention was statistically significant (P 0.05). 2. When the pupil diameter was 6 mm, the spherical aberration before the intervention was (0.05). After intervention with 1% cyclopentolate hydrochloride, 0.5% tropicamide, 0.05% racemic after intervention with scopolamine and 2.5% lincomycin, the spherical aberration was (0.10 + 0.10) micron, (0.08 + 0.11) micron, (0.07 + 0.12) micron, (0.05 + 0.12) micron, 1% cyclopentolate hydrochloride and 0.5% tropicamide, respectively, and the spherical aberration was positively increased with 0.05% racemic intervention. There was no significant change in spherical aberration after the intervention of anisodamine. There was no significant difference in spherical aberration before and after the intervention of four drugs by ANOVA.
Conclusion The effect of 1% cyclopentolate hydrochloride eye drops or 0.5% topicamide eye drops on astigmatism, especially spherical aberration, should be paid attention to in adult myopia patients before excimer laser surgery.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.63

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