中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
CHINESE JOURNAL OF OCULAR TRAUMA AND OCCUPATIONAL EYE DISEASE
2014年
7期
497-502
,共6页
由彩云%陈松%韩琪%赫天耕%颜华
由綵雲%陳鬆%韓琪%赫天耕%顏華
유채운%진송%한기%혁천경%안화
白内障%疾病,全身性,严重%心律失常%梗死,心肌%肾衰竭,慢性
白內障%疾病,全身性,嚴重%心律失常%梗死,心肌%腎衰竭,慢性
백내장%질병,전신성,엄중%심률실상%경사,심기%신쇠갈,만성
Cataract%Disease,systemic,severe%Arrhythmia%Infarction,myocardial%Renal failure,chronic
目的 评价伴有严重全身疾病的白内障患者术前处理及手术效果.方法 分析我院手术的伴有严重全身疾病的白内障246例(393只眼).年龄46 ～ 95岁,平均(73.00±9.26)岁.术前视力光感～0.6.全身疾病包括:循环系统疾病175例(慢性心力衰竭1例,心律失常40例,心绞痛81例,心肌梗死47例,心脏瓣膜病4例,心肌疾病2例),呼吸系统疾病26例,脑血管疾病62例,慢性肾衰竭17例(其中7例尿毒症期),特发性血小板减少性紫癜3例,免疫系统疾病20例,合并恶性肿瘤者29例.术前处理方法:心脏支架或搭桥患者术前7d停用抗凝药物,改用低分子肝素.肾透析患者术前1d肾透析时使用0.4 ml低分子肝素,术后使用鱼精蛋白中和肝素.手术方式:行晶状体超声乳化吸出术230例(372只眼),小切口白内障囊外摘出术16例(21只眼).所有术眼囊袋内植入后房型人工晶状体.术后随访1 ～12个月.结果 所有患者术中均在心电监护和持续低流量吸氧实施下顺利完成白内障手术.术后视力提高385只眼(97.96％),视力不变8只眼(2.04％).术后最佳矫正视力0.25及以下者20只眼(5.09％),0.3至0.5者59只眼(15.01％),0.6至0.8者141只眼(35.88％),1.O及以上者173只眼(44.02％).术中血压升高13例(5.28％),立即静脉注射药物将血压降到正常范围.术后并发症包括角膜水肿52只眼(13.23％),前房渗出4只眼(1.02％),前房少量积血1只眼(0.25％),暂时性高眼压5只眼(1.27％).术后随访全身疾病无明显进展.结论 对于伴有严重全身疾病的白内障患者术前积极控制全身疾病,可使手术顺利进行.手术安全可靠,效果良好.
目的 評價伴有嚴重全身疾病的白內障患者術前處理及手術效果.方法 分析我院手術的伴有嚴重全身疾病的白內障246例(393隻眼).年齡46 ～ 95歲,平均(73.00±9.26)歲.術前視力光感～0.6.全身疾病包括:循環繫統疾病175例(慢性心力衰竭1例,心律失常40例,心絞痛81例,心肌梗死47例,心髒瓣膜病4例,心肌疾病2例),呼吸繫統疾病26例,腦血管疾病62例,慢性腎衰竭17例(其中7例尿毒癥期),特髮性血小闆減少性紫癜3例,免疫繫統疾病20例,閤併噁性腫瘤者29例.術前處理方法:心髒支架或搭橋患者術前7d停用抗凝藥物,改用低分子肝素.腎透析患者術前1d腎透析時使用0.4 ml低分子肝素,術後使用魚精蛋白中和肝素.手術方式:行晶狀體超聲乳化吸齣術230例(372隻眼),小切口白內障囊外摘齣術16例(21隻眼).所有術眼囊袋內植入後房型人工晶狀體.術後隨訪1 ～12箇月.結果 所有患者術中均在心電鑑護和持續低流量吸氧實施下順利完成白內障手術.術後視力提高385隻眼(97.96％),視力不變8隻眼(2.04％).術後最佳矯正視力0.25及以下者20隻眼(5.09％),0.3至0.5者59隻眼(15.01％),0.6至0.8者141隻眼(35.88％),1.O及以上者173隻眼(44.02％).術中血壓升高13例(5.28％),立即靜脈註射藥物將血壓降到正常範圍.術後併髮癥包括角膜水腫52隻眼(13.23％),前房滲齣4隻眼(1.02％),前房少量積血1隻眼(0.25％),暫時性高眼壓5隻眼(1.27％).術後隨訪全身疾病無明顯進展.結論 對于伴有嚴重全身疾病的白內障患者術前積極控製全身疾病,可使手術順利進行.手術安全可靠,效果良好.
목적 평개반유엄중전신질병적백내장환자술전처리급수술효과.방법 분석아원수술적반유엄중전신질병적백내장246례(393지안).년령46 ～ 95세,평균(73.00±9.26)세.술전시력광감～0.6.전신질병포괄:순배계통질병175례(만성심력쇠갈1례,심률실상40례,심교통81례,심기경사47례,심장판막병4례,심기질병2례),호흡계통질병26례,뇌혈관질병62례,만성신쇠갈17례(기중7례뇨독증기),특발성혈소판감소성자전3례,면역계통질병20례,합병악성종류자29례.술전처리방법:심장지가혹탑교환자술전7d정용항응약물,개용저분자간소.신투석환자술전1d신투석시사용0.4 ml저분자간소,술후사용어정단백중화간소.수술방식:행정상체초성유화흡출술230례(372지안),소절구백내장낭외적출술16례(21지안).소유술안낭대내식입후방형인공정상체.술후수방1 ～12개월.결과 소유환자술중균재심전감호화지속저류량흡양실시하순리완성백내장수술.술후시력제고385지안(97.96％),시력불변8지안(2.04％).술후최가교정시력0.25급이하자20지안(5.09％),0.3지0.5자59지안(15.01％),0.6지0.8자141지안(35.88％),1.O급이상자173지안(44.02％).술중혈압승고13례(5.28％),립즉정맥주사약물장혈압강도정상범위.술후병발증포괄각막수종52지안(13.23％),전방삼출4지안(1.02％),전방소량적혈1지안(0.25％),잠시성고안압5지안(1.27％).술후수방전신질병무명현진전.결론 대우반유엄중전신질병적백내장환자술전적겁공제전신질병,가사수술순리진행.수술안전가고,효과량호.
Objective To evaluate the efficacy of cataract surgery and preoperative treatment for cataract patients with severe systemic diseases.Methods Data of 393 eyes of 246 cataract patients with severe systemic disease who underwent cataract surgery in our hospital were retrospectively analyzed.The age was from 46 to 95 years old with average (73.00 ± 9.26) years.The preoperative visual acuity ranged from light perception to 0.6.There were 175 patients with circulatory systemic diseases:1 patient with chronic heart failure,40 patients with arrhythmia,81 patients with angina,47 patients with myocardial infarction,4 patients with valvular disease and 2 patients with myocardiopathy.Other systemic diseases included respiratory systemic diseases in 26 patients,cerebrovascular diseases in 62 patients,chronic renal failure in 17 patients (uraemia in 7),idiopathic thrombocytopenic purpura in 3 patients,and diseases of immune system in 20 patients,cancers in 29 patients.The preoperative managements included:low molecular Heparin instead of anticoagulant used in patients with cardiac bypass surgery or coronary stent implantation 7 days preoperatively,low molecular Heparin 0.4 ml used during renal dialysis in patients with renal insufficiency 1 day before surgery and Protamine used postoperatively to neutralize Heparin.The surgical options included:phacoemulsification in 230 patients (372 eyes) and extracapsular cataract extraction in 16 patients (21 eyes).Posterior chamber intraocular lens were implanted in the bag in all patients.The follow-up time was from 1 to 12 months.Results All the surgeries were performed successfully under electrocardiograph monitoring and continuous low flow oxygen inhalation.The postoperative best corrected visual acuity increased in 385 eyes (97.96％),and remained unchanged in 8 eyes (2.04％).The best corrected visual acuity was 0.25 or below in 20 (5.09％) eyes,between 0.3 and 0.5 in 59 (15.01％) eyes,between 0.6 and 0.8 in 141 (35.88％) eyes,and 1.0 or better in 173 (44.02％) eyes.During operation,blood pressure elevated in 13 patients (5.28％) and was controlled by intravenous injection of medicine immediately.Postoperatively,cornea edema occurred in 52 eyes (13.23 ％),exudation in anterior chamber in 4 eyes (1.02％),hyphema in 1 eye (0.25％),and temporary elevation of intraoeular pressure in 5 eyes (1.27％) respectively.No obvious progression of systemic disease was observed during follow-up period.Conclusion Under proper preoperative management of systemic diseases,patients with severe systemic diseases can undergo cataract surgery successfully and gain better prognosis.
