药物治疗中的青光眼患者自我监测24小时眼压的临床效果  

Clinical Effect of Self-Monitoring 24-Hour Intraocular Pressure in MedicalTreated Glaucoma Patients

作　　者：刘瑞 赵平 谭娟 彭悦 郑伊苹 

机构地区：[1]中南大学爱尔眼科学院,长沙410000 [2]沈阳爱尔眼视光医院,110000

出　　处：《中华眼视光学与视觉科学杂志》2020年第1期20-26,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:评估自我监测24 h眼压在药物治疗原发性开角型青光眼(POAG)患者中的临床效果。方法:系列病例研究。选取2017年8月至2019年1月就诊于沈阳爱尔眼视光医院行药物治疗且随访眼压控制良好的POAG患者42例(73眼),根据基线眼压分为A组:眼压为(12.86±1.40)mmHg(1 mmHg=0.133 kPa);B组:眼压为(17.82±1.40)mmHg。入组患者通过iCare HOME回弹式眼压计使用培训认证后于家中自行测量24 h眼压,自730起每隔2 h测量1次,夜间2330-530测量苏醒后即刻的坐位眼压。比较组间各时间段眼压均值、峰值及波动值,并统计眼压峰值时间点和更改治疗方案的患者比例。数据采用单因素方差分析、Kruskal-Wallis H检验、t检验以及χ2检验进行分析。结果:入组患者随访、门诊时间以及24 h的平均眼压总体差异无统计学意义(F=1.314,P=0.271)。入组患者24 h眼压峰值高于门诊时间的眼压峰值、随访眼压峰值(H=-40.979、-51.363,均P<0.001)。83.6%的患者眼压峰值出现在非门诊时间(A组86.5%、B组80.6%),尤其是发生在夜间睡眠时间,其比例高达67.1%(A组64.9%、B组69.4%)。入组患者以及A、B亚组患者的24 h眼压波动值均高于其门诊时间眼压波动值(t=11.166、8.110、7.929,均P<0.001),其中63.0%的患者24 h眼压波动值≥8 mmHg(A组51.4%、B组75.0%)。根据自我监测24 h的眼压结果,49.3%的患者更改治疗方案,且B组患者更改比例(63.9%)高于A组(35.1%),差异有统计学意义(χ2=6.035,P=0.014)。结论:药物治疗中的POAG患者自行监测24 h眼压,能发现临床常规随访中无法监测到的眼压峰值和波动值,可作为医师评价疗效和调整治疗方案的重要依据。Objective:To evaluate the clinical significance of self-monitoring 24-hour intraocular pressure(IOP)in primary open angle glaucoma(POAG)patients with medical treatment.Methods:This was a case series study.Forty-two POAG patients who had acceptable clinic IOP reading controlled by medicine were selected in shenyang Aier Eye Hospital from August 2017 to January 2019,and divided into group A(IOP:12.86±1.40 mmHg)and group B(IOP:17.82±1.40 mmHg)based on the baseline IOP.All participants were trained to use the iCare HOME rebound tonometer to measure 24-hour IOP at home by themselves after certification.24-hour IOP values was obtained every 2 hour starting from 7:30.The IOP was measured immediately in sitting position after waking up during 23:30 to 5:30.The observation indices included mean IOP,peak IOP and IOP fluctuation amplitude in different periods.The timing of peak IOP and the proportion of patients changing treatment were counted.One-way ANOVA,Kruskal-Wallis H test,t-tests andχ2 test were used to analyze the data.Results:There was no significant difference among the mean IOP measured in the period of clinic,office hours and 24-hour(F=1.314,P=0.271).The peak IOP during 24-hour was higher than that during office hours and that during the clinic period(H=-40.979,-51.363,all P<0.001).83.6%of the patients'peak IOP occurred outside the office hours(86.5%in group A and 80.6%in group B),especially in the night,with a proportion as high as 67.1%(64.9%in group A and 69.4%in group B).The 24-hour IOP fluctuation of all patients,as well as the patients in group A and group B,were higher than that during office hours(t=11.166,8.110,7.929,all P<0.001).63.0%patients'24-hour IOP fluctuation was greater than or equal to 8 mmHg(51.4%in group A,75.0%in group B).49.3%patients'clinical management was changed based on the result of self-monitoring 24-hour IOP,and the changing proportion in group B(63.9%)was higher than that in group A(35.1%)(χ2=6.035,P=0.014).Conclusions:Self-measurement of 24-hour IOP in POAG patients with medi

关 键 词：原发性开角型青光眼 眼压计 24小时眼压 

分 类 号：R47[医药卫生—护理学]