CAJ | 학술논문

目的：观察眼部热金属烧伤的临床特点及治疗方式。方法回顾性分析山东省眼科医院2004年9月至2012年12月因眼部热金属烧伤入院的患者47例（54只眼），对烧伤部位的临床特点，热金属种类、烧伤程度、面积之间的关系，远期并发症及治疗结果进行小结。结果眼部金属热烧伤有以下临床特点：（1）烧伤主要局限于热金属直接作用的部位：球结膜局限性缺血坏死面积小于1/4者25只眼（56．8％），21只眼位于下方；（2）金属直接作用于角膜的部位有较为严重的组织自溶：26只眼（48．2％）角膜自溶中20只眼位于下方近角膜缘处，具有面积小、深度深、溶解快的特点；（3）眼睑烧伤多见：角膜、结膜受损的同时伴有眼睑烧伤48只眼（88．9％），29只眼睑板糜烂坏死留有瘢痕；（4）不同温度的热金属（铁水和铝水）对角膜的损伤程度差异无统计学意义（卡方＝0．926， P＞0．05）；（5）烧伤后6周眼表是否稳定与结膜、角膜损伤面积的大小有关（卡方＝4．456， P ＜0．05；卡方＝8．145， P ＜0．01）；（6）远期并发症中睑球粘连的发生率较高，25只眼，占55．6％。治疗结果：（1）18只眼（37．5％）因眼睑缺损、眼球暴露影响眼表稳定行永久性睑裂缝合术；（2）早期（3 d内）是否行羊膜移植术与角膜自溶的发生有关（卡方＝5．035， P ＜0．05）。结论高温热金属对眼部的损伤主要局限于金属直接作用的下方球结膜及角膜，随病情发展有严重的组织自溶。烧伤程度与热金属的温度无关，烧伤面积的大小影响愈合程度。早期羊膜移植术可缓解烧伤程度。伴有眼睑的烧伤较多，永久性睑裂缝合术可有效改善眼睑缺损、眼球暴露。
목적：관찰안부열금속소상적림상특점급치료방식。방법회고성분석산동성안과의원2004년9월지2012년12월인안부열금속소상입원적환자47례（54지안），대소상부위적림상특점，열금속충류、소상정도、면적지간적관계，원기병발증급치료결과진행소결。결과안부금속열소상유이하림상특점：（1）소상주요국한우열금속직접작용적부위：구결막국한성결혈배사면적소우1/4자25지안（56．8％），21지안위우하방；（2）금속직접작용우각막적부위유교위엄중적조직자용：26지안（48．2％）각막자용중20지안위우하방근각막연처，구유면적소、심도심、용해쾌적특점；（3）안검소상다견：각막、결막수손적동시반유안검소상48지안（88．9％），29지안검판미란배사류유반흔；（4）불동온도적열금속（철수화려수）대각막적손상정도차이무통계학의의（잡방＝0．926， P＞0．05）；（5）소상후6주안표시부은정여결막、각막손상면적적대소유관（잡방＝4．456， P ＜0．05；잡방＝8．145， P ＜0．01）；（6）원기병발증중검구점련적발생솔교고，25지안，점55．6％。치료결과：（1）18지안（37．5％）인안검결손、안구폭로영향안표은정행영구성검렬봉합술；（2）조기（3 d내）시부행양막이식술여각막자용적발생유관（잡방＝5．035， P ＜0．05）。결론고온열금속대안부적손상주요국한우금속직접작용적하방구결막급각막，수병정발전유엄중적조직자용。소상정도여열금속적온도무관，소상면적적대소영향유합정도。조기양막이식술가완해소상정도。반유안검적소상교다，영구성검렬봉합술가유효개선안검결손、안구폭로。
Objective To investigate the clinical characteristics and treatment methods for ocular thermal burns by hot metal liquid .Results There were 47 patients ( 54 eyes ) with ocular thermal burns by hot metal liquid admitted to Shandong Eye Hospital between September 2004 and December 2012.Histories of these patients were analyzed retrospec-tively.The clinical characteristics of the burns , types of the metal , degree of injuries to the eye , relationship between burn-ed areas and long Pterm complications and treatment outcomes were analyzed .Results Eye metal thermal burns has the fol-lowing clinical features:(1)Burns were mainly limited to the area of hot metal direct contact: focal conjunctival ischemic necrosis were less than a quarter in 25 eyes (56.8%), and in 21 eyes, it located in lower part of the conjunctiva .(2) Se-vere tissue autolysis were found at the part of the cornea that had direct metal contact :in 20 out of 26 eyes which had the cornea autolysis, it located near the limbus, and was small, deep, and fast resolved.(3) Eyelid burns were more com-mon:in 48 eyes damaged corneal or conjunctival accompanied with eyelid injuries (88.9%), and in 29 eyes the eyelid plate progressed to local erosive necrosis and scar formation .(4) There was no significant difference in the degree of corne-al injury caused by burns with metals of different temperatures ( e.g., molten iron or molten aluminum , chi-square =0.926;P >0.05).(5) The stability of ocular surface at 6 weeks after burns was related to the injury size in conjunctiva (chipsquare=4.456, P <0.05) and cornea (chi-square=8.145, P <0.01).(6) There was a higher incidence of sym-blepharon (25 eyes, 55.6%).Regarding the therapeutic outcome: (1) 18 eyes (37.5%) received permanent tarsor-rhaphy because of damaged eyelid and consequently eyeball exposure .( 2 ) Whether corneal autolysis would occur was linked to whether early (within 3 days) amniotic membrane transplantation was performed (chi -square =5.035, P <0.05 ) .Conclusion The ocular injury by high temperature metal is mainly limited to the area on conjunctiva and /or corne-al with direct contact .Severe tissue autolysis may occur in later phase .The degree of injuries is not related to the tempera-ture of the metal , while the size of burns area affects healing .Early amniotic membrane transplantation improves outcomes . Accompanied eyelid burns may require permanent palpebral fissure surgeries to correct the eyelid deformation and eyeball exposure.