低温冲洗联合局部冷敷对降低Trans-PRK术后疼痛及炎性反应的效果分析  

Analysis on effect of hypothermia washing combined with local cold compress on postoperative pain and inflammatory reaction in Trans-PRK operation

作　　者：周友惠 熊洁 张辰星 霍姝佳 周青青 罗启惠 王科 ZHOU Youhui;XIONG Jie;ZHANG Chenxing;HUO Shujia;ZHOU Qingqing;LUO Qihui;WANG Ke(Department of Ophthalmology,First Affiliated Hospital,Army Military Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院眼科,重庆400038

出　　处：《重庆医学》2020年第21期3574-3577,共4页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2018MSXM024)。

摘　　要：目的探讨术中使用低温(4℃)平衡盐溶液冲洗结膜囊联合术后冷敷对降低经上皮准分子激光屈光性角膜切削术(Trans-PRK)术后疼痛及炎性反应的临床效果。方法将100例(200眼)Trans-PRK手术患者分为两组,每组50例(100眼)。Trans-PRK激光切削后,观察组采用4℃平衡盐溶液冲洗结膜囊联合术后即刻冷敷术眼1 h,对照组使用常温20℃平衡盐溶液冲洗结膜囊,术后不冷敷。密切随访3个月,评估患者手术后当天及术后1、2 d疼痛程度,观察术后5、14、30、60 d裸眼视力及角膜上皮恢复程度、炎性反应、角膜上皮下混浊等指标并进行统计学分析。结果术前两组患者各指标比较,差异均无统计学意义(P>0.05)。手术当天观察组患者疼痛评分明显低于对照组(P=0.001),术后1、2 d两组患者疼痛评分比较,差异均无统计学意义(P=0.060、0.072)。观察组患者手术当天疼痛评分明显低于术后1 d(P=0.007),与术后2 d比较,差异无统计学意义(P=0.070);术后2 d疼痛评分明显低于术后1 d(P=0.001)。对照组手术当天疼痛评分与术后1 d比较,差异无统计学意义(P=0.392);术后2 d疼痛评分明显低于手术当天及术后1 d(P=0.001、0.001)。两组疼痛感均于术后2 d明显缓解。观察组术后5 d角膜上皮愈合程度明显优于对照组(P<0.05),结膜充血明显轻于对照组(P<0.05);术后14 d两组患者角膜上皮愈合程度、眼表充血程度及术后各时间点裸眼视力、角膜上皮下混浊比较,差异均无统计学意义(P>0.05)。结论低温冲洗联合冷敷可减轻术后疼痛及炎性反应。Objective To observe the clinical efficacy of washing conjunctiva sac with 4°balance salt solution combined with postoperative cold compress on reducing postoperative pain and inflammatory reaction in Trans-PRK operation.Methods One hundred cases(200 eyes)of Trans-PRK were divided into the two groups,50 cases(100 eyes)in each group.After Tans-PRK laser ablation,the observation group adopted the conjunctiva sac flushing with 4°balance salt solution combined with cold compress for 1 h in the operated eye,while the control group used 20°balance salt solution for flushing conjunctiva sac without postoperative cold compress.The close follow up lasted for 3 months.The pain degree of the patients on the operation day,postoperative 1,2 d was evaluated.The uncorrected visual acuity(UCVA),corneal epithelial recovery degree,inflammation reaction and haze of corneal epithelium were observed on postoperative 5,14,30 and 60 d.Results The various indexes before operation had no statistically significant difference between two groups(P>0.05).The pain score on the operation day in the experiment group was lower than that in the control group(P<0.05),while which on postoperative 1,2 d had no statistically significant difference between two group(P>0.05).The pain score on postoperative 2 d was significantly lower that on postoperative 1 d(P=0.001).The pain score in the control group had no statistical difference between the operation day and postoperative 1 d(P=0.392);the pain score on postoperative 2 d was significantly lower than that on the operation day and postoperative 1 d(P=0.001,0.001).The pain feeling in the two groups was significantly relieved on postoperative 2 d.The corneal epithelial healing degree on postoperative 5 d in the observation group was significantly better than that in the control group(P<0.05),and the conjunctiva congestion was significantly lighter than that in the control group(P<0.05).The corneal epithelial healing degree,ocular surface congestion degree,uncorrected visual acuity at each time point

关 键 词：低温冲洗 冷敷 经上皮准分子激光屈光性角膜切削术 炎性反应 疼痛 角膜上皮下混浊 

分 类 号：R778[医药卫生—眼科]