葡萄膜炎药物治疗中的问题分析  

Evaluation of the problems in the treatment of uveitis

作　　者：杨培增[1] 王红[1] 周红颜[1] 俞琼[1] 钟晖[1] 黄祥坤[1] 傅涛[1] 陈玲[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华眼科杂志》2004年第10期679-682,共4页Chinese Journal of Ophthalmology

基　　金：国家杰出青年基金资助项目 ( 3 992 5 0 3 4);国家自然科学基金资助项目 ( 3 0 1710 0 2 );广东省"千百十工程"人才培养基金资助项目 (千 9949)

摘　　要：目的　探讨葡萄膜炎临床治疗中的误区和可能原因。方法　收集 2 0 0 0年 4～ 10月中山大学中山眼科中心葡萄膜炎专科就诊的 15 4例患者 (2 6 8只眼 )的完整资料 ,归纳、分析其治疗资料 ,尤其是糖皮质激素的给药途径、剂量和治疗时间以及抗生素应用等方面的情况。结果　 15 4例 (2 6 8只眼 )患者中糖皮质激素滴眼数、结膜下或球后注射眼数及全身应用例数的使用率分别为 90 3%、84 0 %及 92 9% ,而全身应用糖皮质激素的患者中静脉滴注者占 85 3%。Behcet病 (37例 )、前葡萄膜炎 (30例 )及Fuchs虹膜异色性葡萄膜炎 (14例 )患者的既往治疗情况显示 ,县级、地市级和省级医院(包括省级以上医院和医学院校附属医院 )的糖皮质激素应用中普遍存在着大剂量滥用或滴眼剂使用不当的现象。 15 4例葡萄膜炎患者中抗生素滴眼数、结膜下注射眼数及全身应用例数的使用率分别为 97 0 %、71 6 %及 83 8% ;仅 6例 (3 9% )应用了其他免疫抑制剂。结论　内源性非感染性葡萄膜炎尤其是Behcet病、前葡萄膜炎及Fuchs虹膜异色性葡萄膜炎患者治疗中糖皮质激素和抗生素的滥用和误用现象相当普遍 ;糖皮质激素的应用途径、剂量及治疗时间应根据葡萄膜炎的类型和严重程度等而定 ;非感染性葡萄膜炎不需要使用抗生素。Objective To address the problems present in the treatment of uveitis. Methods A retrospective analysis was made on 154 patients (268 eyes) with different enti ties of uveitis, coming from all over China and referring to Zhongshan ophthalmi c center from April to October of 2000. The data of these patients, especially with respect to the usage of corticosteroids and antibiotics in the referred hos pitals, were analyzed. Results Corticosteroids drops, subconjunctival or retrobulbar injection and systemic cor ticosteroids were respectively used in 90.3% and 84.0% of these eyes, and 92. 9% of these cases. Intravenous injection of corticosteroids was rather popular, accounting for 85.3% of the cases who were treated with systemic corticosteroi ds. Improperly aggressive treatment with corticosteroids or undue application o f their eye drops was equally found in patients from county-, city- and provi nce-level hospitals, especially in Behcet′s disease, anterior uveitis and Fuch s heterochromic uveitis. Antibiotics drops, subconjunctival injection and syste mic administration of antibiotics were respectively used in 97.0% and 71.6% of these eyes and 83.8% of these patients. Immunosuppressive drugs, other than t he corticosteroids, were used in 6 patients only. Conclusions Corticosteroids should be used in proper methods, dosage and duration base d on the entities and severity of uveitis. It is not necessary to treat non-in fectious uveitis with antibiotics. (Chin J Ophthalmol, 2004,4 0: 679-682)

关 键 词：葡萄膜炎 糖皮质激素 患者 全身 抗生素 治疗时间 BEHCET病 问题分析 专科 结论 

分 类 号：R773[医药卫生—眼科] R197[医药卫生—临床医学]