增殖期糖尿病视网膜病变围手术期干预的临床效果  

Clinical effect of perioperative interventions on breeding period diabetic retinopathy

作　　者：姜世怀[1] 乔岗[1] 王科[1] 曾晓红[1] 李桂蓉[1] 

机构地区：[1]中国四川省绵阳市中医医院南桥眼科分院,621000

出　　处：《国际眼科杂志》2013年第4期759-761,共3页International Eye Science

摘　　要：目的:分析增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者进行围手术期干预的临床效果。方法:回顾性分析2009-05/2011-12我院40例52眼糖尿病视网膜病变的病历及随访资料,其中男15例20眼,女25例32眼,年龄31～78岁。全部患者术前均进行视力、眼压、裂隙灯显微镜眼底检查、眼B超、角膜内皮镜等检查,术后1,2wk;1,2,3,6mo随访,观察患者的视力、眼压、人工晶状体、眼底情况,围手术期观察患者的血糖、血压、全身情况、不良事件等结果。全部患者实施围手术期干预措施。依据患者患有的与糖尿病相关的全身合并症的诊断进行评分,每种合并症记1分,无合并症记0分。手术方式为玻璃体切割+全视网膜光凝,合并黄斑水肿及黄斑前膜者行黄斑內界膜剥离,合并白内障者同期行白内障超声乳化吸出,I期植入或不植入人工晶状体,根据术中情况眼内填充长效气体/硅油/曲安奈德;术中常规进行心电监护,出现明显血压波动者在麻醉医师监护下行控制性降压。结果:所有糖尿病视网膜病变患者中Ⅰ型5例,双眼手术者12例(30%),左右眼各14例(35%)。PDR Ⅳ期15眼(28.8%),Ⅴ期16眼(30.8%),Ⅵ期21眼(40.4%)。术前视力低于0.02者38眼(73.1%),0.02～0.1者7眼(13.5%),0.1～0.3者5眼(9.6%),0.3以上者2眼(3.8%)。术后随访视力低于0.02者17眼(32.7%),0.02～0.1者9眼(17.3%),0.1～0.3者14眼(26.9%),0.3以上者12眼(23.1%)。1次手术治愈者47眼(90.4%),再次手术者5眼(9.6%);术后早期轻度玻璃体再出血者5眼(9.6%),晚期玻璃体再出血合并新生血管性青光眼者1眼(1.9%),感染性眼内炎者1眼(1.9%)。本组患者在我院内科确诊患有合并症的患者为17例(42.5%),无合并症的23例(57.5%),评分为0分者23例(57.5%),1分者9例(22.5%),2分者4例(10%),3分者3例(7.5%),4分者1例(2.5%)。术中实施控制性降血压者5眼(9.6%)。全部患者围手术期血糖、血压及全身情况稳定,无不�AIM： To analyze the clinical effect of perioperative intervention in proliferative diabetic retinopathy （PDR） patients. METHODS： Totally 52 cases of eye diabetic retinopathy with medical records and follow- up materials were retrospectively analyzed from May 2009 to December 2011, male 15 cases, female 25 cases, age 31 - 78 years old, all patients underwent preoperative visual acuity, intraocular pressure, slit lamp microscope, slit lamp microscope eye fundus examination, B ultrasonic, corneal endothelial mirror etc. After 1 week, 2 weeks, 1 month, 2, 3, 6 months follow-up, the patients were observed the vision, intraocular pressure, artificial crystal, fundus, perioperative observation of patients with blood glucose, blood pressure, systemic, adverse events, and so on. Implementation of all patients perioperative interventions. According to the patients with diabetes related systemic complications diagnosis rating, each complication was recorded as 1 point, no complication O. Operation method for vitrectomy ＋ full retinal photocoagulation, merger macular edema and macular front wall line macular inside boundary film stripping, who do the same period with cataract phacoemulsification, stage I or implant implantation of artificial crystal, according to the intraoperative situation intraocular filling long-term gas/ oil/song amine Ned; During the operation, the conventional for ecg monitoring, appear obvious blood pressure fluctuation in anesthesia physician care descending controlled decompression. RESULTS： Forty cases of 52 eyes of diabetic retinopathy in patients with type I 5 cases, eyes surgery of 12 patients （30%）, each eye around 14 cases （35%）, PDR stage IV 15 eyes （28.8%）, V stage 16 eyes （30.7%）, Vl period 21 eyes （40.3%）. Preoperative sight is lower than 0.02 and eyes （73.1%）, 0.02 - 0.1 7 （13.5%） eye, 0.1 - 0.3 5 eyes （9.6%）, more than 0.32 eyes （3.8%）. In the follow-up of sight is lower than 0.02 17 eyes （32.7%）, 0.02 - 0.1 9 eyes （32.7%）, 0.1 -

关 键 词：糖尿病性视网膜病变 玻璃体手术 围手术期 并发症 预防 

分 类 号：R779.6[医药卫生—眼科]