CAJ | 학술논문

目的评价伴有严重全身疾病的玻璃体切割手术患者围手术期处理效果及手术疗效.方法对伴有严重全身疾病的玻璃体切割手术患者21例22只眼的临床资料进行回顾分析.增生型糖尿病视网膜病变11例12只眼,孔源性视网膜脱离9例9只眼,人工晶状体脱位1例1只眼.手术前视力手动～0.6.全身疾病包括肾功能不全行肾透析4例,心肌梗死或冠状动脉狭窄行心脏搭桥或冠状动脉支架植入手术7例,严重心律失常行心脏起搏器植入或心脏射频消融手术2例,脑梗死5例,血友病2例,再生障碍性贫血1例.心肌梗死或冠状动脉狭窄患者手术前7 d停用抗凝药物,改用低分子肝素.肾功能不全患者手术前1 d肾透析时使用0.4 ml低分子肝素,手术后使用鱼精蛋白中和肝素.乙型血友病患者手术前1 d输注凝血酶原复合物,手术后连续5 d输注凝血酶原复合物.手术中行白内障超声乳化6例6只眼,睫状沟人工晶状体缝线固定复位手术1例1只眼.手术中硅油填充14例14只眼,C3F8填充5例6只眼,无填充物2例2只眼.结果手术后视力为光感～1.0.其中,视力提高18例19只眼,不变2例2只眼,下降1例1只眼.所有患眼视网膜复位.手术后并发症包括前房少量出血4例4只跟,前房大量出血1例1只眼,视网膜表面少量出血2例2只眼,视盘表面少量出血2例3只眼,暂时性高眼压1例1只眼,新生血管性青光眼1例1只眼.手术后1周内血肌酐升高1例,血压升高1例,其余患者未出现原有全身疾病加重的情况.结论严重全身疾病不是玻璃体切割手术的绝对禁忌症.只要围手术期积极控制全身疾病,玻璃体切割手术可顺利进行,并取得较好效果.
목적 평개반유엄중전신질병적파리체절할수술환자위수술기처리효과급수술료효.방법 대반유엄중전신질병적파리체절할수술환자21례22지안적림상자료진행회고분석.증생형당뇨병시망막병변11례12지안,공원성시망막탈리9례9지안,인공정상체탈위1례1지안.수술전시력수동～0.6.전신질병포괄신공능불전행신투석4례,심기경사혹관상동맥협착행심장탑교혹관상동맥지가식입수술7례,엄중심률실상행심장기박기식입혹심장사빈소융수술2례,뇌경사5례,혈우병2례,재생장애성빈혈1례.심기경사혹관상동맥협착환자수술전7 d정용항응약물,개용저분자간소.신공능불전환자수술전1 d신투석시사용0.4 ml저분자간소,수술후사용어정단백중화간소.을형혈우병환자수술전1 d수주응혈매원복합물,수술후련속5 d수주응혈매원복합물.수술중행백내장초성유화6례6지안,첩상구인공정상체봉선고정복위수술1례1지안.수술중규유전충14례14지안,C3F8전충5례6지안,무전충물2례2지안.결과 수술후시력위광감～1.0.기중,시력제고18례19지안,불변2례2지안,하강1례1지안.소유환안시망막복위.수술후병발증포괄전방소량출혈4례4지근,전방대량출혈1례1지안,시망막표면소량출혈2례2지안,시반표면소량출혈2례3지안,잠시성고안압1례1지안,신생혈관성청광안1례1지안.수술후1주내혈기항승고1례,혈압승고1례,기여환자미출현원유전신질병가중적정황.결론 엄중전신질병불시파리체절할수술적절대금기증.지요위수술기적겁공제전신질병,파리체절할수술가순리진행,병취득교호효과.
Objective To evaluate the efficacy of perioperative management for vitrectomy of patients with severe systemic disease. Methods The clinical data of 21 patients (22 eyes) with severe systemic disease who underwent vitrectomy were retrospectively analyzed. There were 11 patients (12 eyes) with proliferative diabetic retinopathy, 9 patients (9 eyes) with rhegmatogenous retinal detachment, and 1 patient (1 eye) with intraocular lens dislocation. The preoperative visual acuity ranged from hand movement to 0.6.There were 4 patients (5 eyes) with renal insufficiency undergoing renal dialysis, 7 patients (7 eyes) with myocardtal infarction or coronary artery stenosis received cardiac bypass surgery or coronary stent implantation, 2 patients (2 eyes) with severe arrhythmia received cardiac pacemaker implantation or radiofrequency catheter ablation, 5 patients (5 eyes) with cerebral infarction, 2 patients (2 eyes) with hemophilia, and 1 patient (1 eye) with aplastic anemia. For patients with cardiac bypass surgery or coronary stent implantation, anticoagulants were switch to low molecular heparin at 7 days before vitrectomy. For patients undergoing renal dialysis, 0.4 ml low molecular heparin was used during renal dialysis at one day before vitrectomy, protamine and heparin were administered after vitrectomy. Prothrombin complex was infused from 1 day before surgery to 5 days after surgery for Hemophilia B patients. 6 patients (6 eyes)underwent phacoemulsification, and 1 patient (1 eye) underwent ciliary sulcus fixed intraocular lens implantation. 14 patients (14 eyes) underwent silicone oil tamponade, 5 patients (6 eyes) underwent C3F8tamponade. Results The postoperative visual acuity ranged from light perception to 1.0. The vision increased in 18 patients (19 eyes), unchanged in 2 patients (2 eyes), and decreased in 1 patient (1 eye).The retina attached in all eyes postoperatively. The postoperative complications mainly included mild anterior chamber bleeding in 4 patients (4 eyes), severe anterior chamber bleeding in 1 patient (1 eye) , mild retinal hemorrhage in 2 patients (2 eyes), optic disc bleeding in 2 patients (3 eyes), temporary elevation of intraocular pressure in 1 patient (1 eye), and neovascular glaucoma in 1 patient (1 eye). Serum creatinine increased in 1 patient and hypertension in 1 patient within 1 week postoperatively. Conclusions Severe systemic disease is not an absolute contraindication for vitrectomy. Vitrectomy can be successfully performed with better outcomes under the proper perioperative management of systemic disease.