医用透明质酸钠与平衡盐溶液在微创玻璃体手术中对眼表保护的影响  

Effect of sodium hyaluronate and balanced salt solution on ocular surface protection during minimally invasive vitreorentinal surgery

作　　者：辛梦 纪芳 代春华 张靖 刘澍 XIN Meng;JI Fang;DAI Chunhua;ZHANG Jing;LIU Shu(Department of Ophthalmology,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,Shandong,China)

机构地区：[1]滨州医学院烟台附属医院眼科,山东烟台264100

出　　处：《山东大学耳鼻喉眼学报》2024年第5期58-65,共8页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：山东省医药卫生科技发展计划项目(2019WS333);滨州医学院附属医院科研计划项目(BY2020KJ56)

摘　　要：目的比较医用透明质酸钠(medical sodium hyaluronate,HA)和平衡盐溶液(balance salt solution,BSS)在增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)微创玻璃体手术(minimally invasive vitreorentinal surgery,MIVS)中对眼表保护的效果及对泪膜稳定性的影响。方法临床随机对照试验:选取PDR患者40例40眼,采用抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物辅助的MIVS治疗。按照随机数字表法将患者分为HA组(20例20眼)、BSS组(20例20眼)。每组术中分别应用HA和BSS保持眼表湿润。分别于术前、术后1、7、30d行眼表疾病指数量表(ocular surface disease index,OSDI)、非侵入性泪膜破裂时间(non-invasive tear break-up time,NITBUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)、角膜荧光染色(corneal fluorescein staining,CFS)及术中角膜透明度的检测和评估。结果OSDI组间比较,术后各个时间点HA组优于BSS组(P_(1d)=0.001、P_(7d)<0.001、P_(30d)=0.001);组内比较,HA组术后1d较术前受损(P_(HA1d)<0.001),术后30d优于术前(P_(HA30d)=0.002),BSS组术后1d、7d较术前受损(P_(BSS1d)<0.001、P_(BSS7d)<0.001)。SⅠt2组组内比较,HA组、BSS组术后1、7d较术前受损(P_(HA1d)<0.001、P_(HA7d)<0.001、P_(BSS1d)<0.001、P_(BSS7d)<0.001),HA组术后30d优于术前(P_(HA30d)<0.001)。NITBUT组间比较,术后7d HA组优于BSS组(P_(7d)<0.001);组内比较,HA组、BSS组术后7d、30d较术前均受损(P_(HA7d)<0.001、P_(HA30d)=0.027、P_(BSS7d)<0.001,P_(BSS30d)=<0.001)。CFS组间比较,术后1d HA组优于BSS组(P_(1d)<0.001);组内比较,HA组、BSS组术后1、7d较术前受损(P_(HA1d)<0.001、P_(HA7d)<0.001、P_(BSS1d)<0.001、P_(BSS7d)<0.001),BSS组术后30d较术前仍受损(P_(BSS30d)=0.024)。术中角膜透明度HA组优于BSS组(P=0.038)。结论在增殖性糖尿病视网膜病变微创玻璃体手术中应用医用透明质酸钠保护眼表,可减轻围手术期眼表损伤,增加术中的可视性,缩短术后泪膜恢复�Objective To evaluate the protective effect of the ocular surface of medical sodium hyaluronate(HA)and balanced salt solution(BSS)in patients with proliferative diabetic retinopathy(PDR)performing minimally invasive vitreorentinal surgery(MIVS).Methods A retrospective case-controlled study was designed.Forty patients(40 eyes)with PDR performed with antivascular endothelial growth factor-assisted MIVS surgery were enrolled in this study,randomly divided into the HA group[20 cases(20 eyes)]and the BSS group[20 cases(20 eyes)].During surgery,HA and BSS were applied to keep the ocular surface moist according to grouping.Ocular surface disease index(OSDI),SchirmerⅠtest(SⅠt),non-invasive tear film break-up time(NITBUT),corneal fluorescein staining(CFS)and corneal transparency during the surgery were performed preoperatively and at 1,7 and 30days postoperatively.Results The OSDI of the HA group was superior to that of the BSS group at all postoperative time points(P_(1d)=0.001、P_(7d)<0.001、P_(30d)=0.001).Intragroup comparison showed that the HA group was more damaged 1day after surgery than preoperative(P_(HA1d)<0.001),and 30days after surgery was better than preoperative(P_(HA30d)=0.002),and the BSS group was more damaged 1day and 7days after surgery than preoperative(P_(BSS1d)<0.001,P_(BSS7d)<0.001).Intragroup comparison in the SⅠt 2 group showed that the damage in the HA group and the BSS group was worse than preoperative(P_(HA1d)<0.001,P_(HA7d)<0.001,P_(BSS1d)<0.001,P_(BSS7d)<0.001),and damage in the HA group was better than preoperative(P_(HA30d)<0.001).Compared to the NITBUT group,the 7d HA group was better than the BSS group(P_(7d)<0.001).Intragroup comparison showed that the damage to the HA group and the BSS group was greater at 7 and 30days postoperatively than preoperatively(P_(HA7d)<0.001,P_(HA30d)=0.027,P_(BSS7d)<0.001,P_(BSS30d)=<0.001).Among the CFS groups,the HA group was better than the BSS group on 1d postoperatively(P_(1d)<0.001).Intragroup comparison showed that the damage in the HA group a

关 键 词：玻璃体视网膜手术 微创 增殖性糖尿病视网膜病变 透明质酸钠 平衡盐溶液 泪膜 

分 类 号：R777[医药卫生—眼科]