微创玻璃体切割术治疗增生性糖尿病视网膜病变术后再出血的影响因素分析  

Analysis of influencing factors of rebleeding after minimally invasive vitrectomy for proliferative diabetes retinopathy

作　　者：黄淑红[1] 姚晶晶 洪芹 HUANG Shu-hong;YAO Jing-jing;HONG Qin(Department of Ophthalmology,Hefei First People's Hospital,Hefei Anhui 230061,China)

机构地区：[1]合肥市第一人民医院眼科,安徽合肥230061

出　　处：《临床和实验医学杂志》2025年第6期670-672,F0003,共4页Journal of Clinical and Experimental Medicine

基　　金：2021年度安徽省卫生健康委科研项目(编号:AHWJ2021b037)。

摘　　要：目的探讨微创玻璃体切割术(PPV)治疗增生性糖尿病视网膜病变(PDR)术后再出血的影响因素。方法回顾性分析2022年12月至2024年6月期间在合肥市第一人民医院接受PPV治疗的102例PDR患者。收集患者的临床资料,包括糖尿病病程、术前血糖控制[糖化血红蛋白(GHb)]、术中注射抗血管内皮生长因子(VEGF)药物、术后血糖管理情况。根据术后再出血与否将患者分为再出血组和未再出血组,比较两组患者的视力改善情况。采用单因素和多因素Logistic回归分析探讨影响术后再出血的因素。结果术后再出血的发生率为18.63%。再出血19例计为再出血组,未再出血83例计为未再出血组。术后3个月,未再出血组患者术后最佳矫正视力(BCVA)为0.40±0.08,明显优于再出血组(0.63±0.10),差异有统计学意义(P<0.05)。单因素分析结果显示,糖尿病病程>15年、术前血糖控制不良(GHb>8%)、术中未注射抗VEGF药物、术后血糖管理不良患者的再出血发生率均高于糖尿病病程<15年、术前血糖控制良好(GHb<8%)、术中注射VEGF药物、术后血糖管理良好的患者,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,糖尿病病程长、术前血糖控制不良、术后血糖管理不良为术后再出血的独立危险因素(P<0.05);术中抗VEGF药物的应用则是术后再出血的保护因素(P<0.05)。结论PPV治疗PDR术后再出血的发生与患者的糖尿病病程、术前血糖控制及术中操作有关。术中注射抗VEGF药物可有效降低再出血风险。Objective To investigate the factors affecting rebleeding after pars plana vitrectomy(PPV)in the treatment of proliferative diabetic retinopathy(PDR).Methods A total of 102 patients with PDR who underwent minimally invasive vitrectomy in Hefei First People's Hospital from December 2022 to June 2024 were retrospectively analyzed.The clinical data of the patients were collected,including the course of diabetes,preoperative blood glucose control[glycosylated hemoglobin(GHb)],intraoperative injection of anti-vascular endothelial growth factor(VEGF)drugs,and postoperative blood glucose management.The patients were divided into the rebleeding group and the non-rebleeding group according to whether they had rebleeding or not,and the visual acuity improvement of the two groups was compared.The influencing factors of postoperative rebleeding were analyzed by univariate and multivariate Logistic regression analysis.Results The incidence of postoperative rebleeding was 18.63%.Nineteen cases of rebleeding were classified as the rebleeding group,and 83 cases of no rebleeding were classified as the non-rebleeding group.At 3 months after operation,the postoperative best corrected visual acuity(BCVA)in the non-rebleeding group was 0.40±0.08,which was significantly better than that in the rebleeding group(0.63±0.10),and the difference was statistically significant(P<0.05).Univariate Logistic regression analysis showed that the incidence of rebleeding in patients with diabetes duration>15 years,poor preoperative blood glucose control(GHb>8%),no intraoperative injection of anti-VEGF drugs,and poor postoperative blood glucose management were higher than those in patients with diabetes duration<15 years,good preoperative blood glucose control(GHb<8%),intraoperative injection of VEGF drugs,and good postoperative blood glucose management,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that long duration of diabetes,poor preoperative blood glucose control and poor postoperative b

关 键 词：增生性糖尿病视网膜病变 微创玻璃体切割术 术后再出血 影响因素 

分 类 号：R779.6[医药卫生—眼科]