羊膜移植治疗不同阶段和不同程度眼碱化学烧伤的效果  

Therapeutic efficacy of amniotic membrane transplantation in different stages and degrees of ocular alkali chemical burns

作　　者：李莹 陈颖欣 高明宏 Li Ying;Chen Yingxin;Gao Minghong(General Hospital of Northern Theater Command,Shenyang 110000,Liaoning Province,China)

机构地区：[1]北部战区总医院,辽宁省沈阳市110000

出　　处：《中国组织工程研究》2023年第11期1772-1779,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:羊膜移植已被用于治疗各阶段眼部化学烧伤,它能促进角膜上皮化、减轻炎症并恢复眼表完整性,防止眼组织融化。目的:通过分析羊膜移植在急性期(伤后7 d)和修复期(8 d-21 d)眼碱化学烧伤中的疗效,以及比较羊膜移植对不同程度眼碱化学烧伤的治疗效果,以探讨羊膜移植在治疗眼碱化学烧伤中的最佳应用时机和作用机制。方法:对2015年11月至2021年12月在北部战区总医院采用羊膜移植治疗的眼碱性化学烧伤共47例(59眼)临床资料进行回顾性分析;急性期组26例(35眼),伤后0.5 h-7 d;修复期组21例(24眼),伤后8-21 d。59眼中39眼为Ⅱ-Ⅲ级(中度烧伤),20眼为Ⅳ-Ⅵ级(重度烧伤)。两组患者均于入院后次日行羊膜移植术。于术前及术后3周,1,2,3个月时观察和记录角膜上皮缺损愈合率、视力、角膜透明度、眼表炎症程度、角膜血管化程度及睑球粘连情况,并进行统计学分析。结果与结论:①术后平均上皮缺损面积、角膜上皮化率、平均完全上皮愈合时间、术后3个月最佳矫正视力、术后角膜透明度分级、睑球粘连发生率及角膜血管化程度、成功率,急性期组均优于修复期组(P<0.05);②随访结束时,两组组内比较中度组羊膜移植成功率显著高于重度组(P<0.05);羊膜移植失败者中多数(65.2%)为重度的眼碱化学烧伤,伴有角膜缘缺血面积较大,经反复多次的羊膜移植眼表无法恢复稳定性,发展为角膜结膜化,伴有角膜中央新生血管浸润及重度睑球粘连,视力降为手动;③结论:急性期是羊膜移植治疗眼碱化学烧伤的最佳应用时机;对于角膜上皮缺损经久不愈的重度眼碱化学烧伤患者,需早期多次行羊膜移植,方可起到支持创面修复的作用;对于术后行多次羊膜移植后仍出现持续性上皮缺损、角结膜有溶解倾向的重度眼碱化学烧伤患者,应停止羊膜移植,需改为永久性睑缘粘连术或结膜瓣掩盖术BACKGROUND:Amniotic membrane transplantation has been used to treat chemical burns of the eyes at various stages.It promotes corneal epithelialization,reduces inflammation,and restores the integrity of the ocular surface,preventing thawing of the ocular tissue.OBJECTIVE:To analyze the efficacy of amniotic membrane transplantation in ocular alkali chemical burns in the acute phase(7 days after injury) and in the repair phase(8-21 days) and to compare the effects of amniotic membrane transplantation in ocular alkali chemical burns with different degrees,in order to explo re the optimal timing and mechanism of amniotic membrane transplantation for ocular alkali chemical burns.METHODS:A retrospective analysis was performed in 47 cases(59 eyes) undergoing amniotic membrane transplantation for ocular alkali chemical burns in the General Hospital of Northern Theater Command,China from November 2015 to December 2021.There were 26 patients(35 eyes),0.5 hours-7 days(including 7 days) after injury,in acute phase group and 21 patients(24 eyes),8-21 days after injury,in repair period group.Of the 59 eyes,39 eyes were gradeⅡ-Ⅲ(moderate burns) and 20 eyes were grade Ⅳ-Ⅵ(severe burns).Patients from both groups underwe nt amniotic membrane transplantation the next day after admission.The corneal epithelial defect healing rate,vision,corneal clarity,degree of ocular surface inflammation,degree of corneal vascularization,and symblepharon were observed and recorded at preoperative and postoperative 3 weeks,1 month,2 months,and 3 months in the two groups.Statistical analyses were then performed.RESULTS AND CONCLUSION:The acute phase group was supe rior to the repair period group in terms of ave rage epithelial defect area,corneal epithelialization rate,ave rage complete epithelial healing time,best corrected visual acuity at 3 months after operation,postoperative corneal transparency grading,incidence of symblepharon,degree of corneal vascularization,and success rate after ope ration(P <0.05).By the end of the follow-up,the s

关 键 词：羊膜移植 眼碱化学烧伤 眼表重建 急性期 修复期 

分 类 号：R446[医药卫生—诊断学] R496[医药卫生—临床医学] R318