摘要
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7d停用抗凝药物，改用低分子肝素。肾功能不全患者手术前1d。肾透析时使用0．4ml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1d输注凝血酶原复合物，手术后连续5d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只眼，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。
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 myocardial 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 C3F8 tamponade. 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 mildanterior 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 neovaseular 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 eontraindication for vitrectomy. Vitreetomy can be successfully performed with better outcomes under the proper perioperative management of systemic disease.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2011年第4期356-359,共4页
Chinese Journal of Ocular Fundus Diseases
