中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
34期
2411-2415
,共5页
程钢炜%赵家良%刘小力%卞爱玲%徐冬冬%张美芬%毛进%马建民
程鋼煒%趙傢良%劉小力%卞愛玲%徐鼕鼕%張美芬%毛進%馬建民
정강위%조가량%류소력%변애령%서동동%장미분%모진%마건민
葡萄膜炎%青光眼,闭角型%穿刺抽液术%瞳孔阻滞%激光周边虹膜切除术
葡萄膜炎%青光眼,閉角型%穿刺抽液術%瞳孔阻滯%激光週邊虹膜切除術
포도막염%청광안,폐각형%천자추액술%동공조체%격광주변홍막절제술
Uveitis%Glaucoma,angle-closure%Paracentesis%Pupillary block%Laser peripheral iridectomy
目的 探讨裂隙灯下前房穿刺联合瞳孔成形术急诊治疗葡萄膜炎继发急性闭角型青光眼(ACG)效果。方法 分别在发病早期对14例葡萄膜炎继发急性ACG患者进行裂隙灯下前房穿刺联合瞳孔成形治疗（穿刺成形组），对10例葡萄膜炎继发急性ACG患者行激光周边虹膜切除术（激光周切组）。通过观察眼压、前房反应、瞳孔阻滞程度、其他不良事件比较近期治疗效果和安全性的差异。结果 穿刺成形组治疗后1h眼压为(9.2±2.1)mm Hg(1 mm Hg=0. 133 kPa)，治疗后48h眼压为(12.4±3.7) mm Hg，10 d后眼压为(14.1±2.6) mm Hg；激光周切组患者治疗后1h眼压为(24.5±7.1)mm Hg，治疗后48 h眼压为（22.2±8.6）mm Hg，10 d后眼压为(19.3±9.3) mmHg。穿刺成形组在治疗后1h及48 h的前房反应与激光周切组差异无统计学意义，在治疗10 d后的前房反应轻于激光周切组；穿刺成形组和激光周切组在治疗10 d内再次出现瞳孔阻滞的患者分别为1例(1/14)和6例(6/10)；穿刺成形组中有2例早期出现瞳孔缘少量出血，均在10 d内吸收。结论 裂隙灯下前房穿刺联合瞳孔成形术可能是一种安全有效的急诊治疗方法，为患者的进一步治疗提供了初步保障。
目的 探討裂隙燈下前房穿刺聯閤瞳孔成形術急診治療葡萄膜炎繼髮急性閉角型青光眼(ACG)效果。方法 分彆在髮病早期對14例葡萄膜炎繼髮急性ACG患者進行裂隙燈下前房穿刺聯閤瞳孔成形治療（穿刺成形組），對10例葡萄膜炎繼髮急性ACG患者行激光週邊虹膜切除術（激光週切組）。通過觀察眼壓、前房反應、瞳孔阻滯程度、其他不良事件比較近期治療效果和安全性的差異。結果 穿刺成形組治療後1h眼壓為(9.2±2.1)mm Hg(1 mm Hg=0. 133 kPa)，治療後48h眼壓為(12.4±3.7) mm Hg，10 d後眼壓為(14.1±2.6) mm Hg；激光週切組患者治療後1h眼壓為(24.5±7.1)mm Hg，治療後48 h眼壓為（22.2±8.6）mm Hg，10 d後眼壓為(19.3±9.3) mmHg。穿刺成形組在治療後1h及48 h的前房反應與激光週切組差異無統計學意義，在治療10 d後的前房反應輕于激光週切組；穿刺成形組和激光週切組在治療10 d內再次齣現瞳孔阻滯的患者分彆為1例(1/14)和6例(6/10)；穿刺成形組中有2例早期齣現瞳孔緣少量齣血，均在10 d內吸收。結論 裂隙燈下前房穿刺聯閤瞳孔成形術可能是一種安全有效的急診治療方法，為患者的進一步治療提供瞭初步保障。
목적 탐토렬극등하전방천자연합동공성형술급진치료포도막염계발급성폐각형청광안(ACG)효과。방법 분별재발병조기대14례포도막염계발급성ACG환자진행렬극등하전방천자연합동공성형치료（천자성형조），대10례포도막염계발급성ACG환자행격광주변홍막절제술（격광주절조）。통과관찰안압、전방반응、동공조체정도、기타불량사건비교근기치료효과화안전성적차이。결과 천자성형조치료후1h안압위(9.2±2.1)mm Hg(1 mm Hg=0. 133 kPa)，치료후48h안압위(12.4±3.7) mm Hg，10 d후안압위(14.1±2.6) mm Hg；격광주절조환자치료후1h안압위(24.5±7.1)mm Hg，치료후48 h안압위（22.2±8.6）mm Hg，10 d후안압위(19.3±9.3) mmHg。천자성형조재치료후1h급48 h적전방반응여격광주절조차이무통계학의의，재치료10 d후적전방반응경우격광주절조；천자성형조화격광주절조재치료10 d내재차출현동공조체적환자분별위1례(1/14)화6례(6/10)；천자성형조중유2례조기출현동공연소량출혈，균재10 d내흡수。결론 렬극등하전방천자연합동공성형술가능시일충안전유효적급진치료방법，위환자적진일보치료제공료초보보장。
Objective To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). Methods In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure ( IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. Results The IOP values for the paracentesis plus pupillary block relief group were (9.2 ±2.1) mm Hg, (12.4 ±3.7) mm Hg and (14.1 ±2.6) mm Hg at 1,48 h and 10 d vs (24.5 ± 7.1 ) mm Hg, (22.2 ± 8.6) mm Hg and ( 19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1 (1/14) patient from the paracentesis plus pupillaxy block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. Conclusion Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG.And it may offer a basis for further therapy.
