文章摘要
术后早期散瞳对DR合并白内障患者眼部血流动力学的影响及散瞳后瞳孔直径达标的相关因素分析
Effect of early pupil dilation after surgery on ocular hemodynamics in patients with diabetic retinopathy complicated with cataract and analysis of correlative factors of affecting pupil diameter up to standard after dilation
投稿时间:2022-06-09  修订日期:2022-06-09
DOI:
中文关键词: 糖尿病视网膜病变  白内障  血流动力学  散瞳  瞳孔直径
英文关键词: Diabetic retinopathy  Cataract  Hemodynamics  Pupil dilation  Pupil diameter
基金项目:河北省卫生和计划生育委员会项目(20180874)
作者单位邮编
陈妍鹏 河北北方学院附属第一医院 075000
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中文摘要:
      目的 探讨术后早期散瞳对糖尿病视网膜病变(DR)合并白内障患者眼部血流动力学的影响,分析影响散瞳后瞳孔直径达标的相关因素。方法 选择2018年1月至2022年1月我院眼科收治的150例行白内障手术治疗的DR合并白内障患者,将患者按随机数字表法分为对照组和观察组,两组术后均给予复方托吡卡胺滴眼液散瞳,对照组于术后7d、14d各散瞳1次,观察组给予早期散瞳治疗,即术后次日开始每日散瞳1次。比较两组术后眼部血流动力学变化。根据术后第14d散瞳后瞳孔直径是否达标分为达标组(瞳孔直径≥5mm)和未达标组(瞳孔直径<5mm),收集患者临床资料,采用多因素Logistic回归分析影响散瞳后瞳孔直径达标的因素。结果 观察组术后14d视网膜中央动脉、睫状后短动脉舒张末期血流速度(EDV)、收缩期速度峰值(PSV)较术后7d增加(P<0.05),阻力指数(RI)较术后7d降低(P<0.05),且术后7d、14d视网膜中央动脉、睫状后短动脉EDV、PSV高于对照组(P<0.05),RI低于对照组(P<0.05)。观察组术后14d散瞳时间较术后7d缩短(P<0.05),散瞳后瞳孔直径较术后7d增大(P<0.05),且观察组术后7d、14d散瞳时间短于对照组(P<0.05),散瞳后瞳孔直径大于对照组(P<0.05)。糖尿病病程>10年、DR增殖期是影响散瞳后瞳孔直径达标的危险因素(P<0.05),术后早期散瞳治疗是其保护因素(P<0.05)。结论 DR合并白内障患者经白内障术后早期散瞳治疗可缩短散瞳时间,改善眼部血流动力学,增加散瞳后瞳孔直径。糖尿病病程、DR严重程度、术后散瞳时机是散瞳后瞳孔直径达标的影响因素。
英文摘要:
      Objective To explore the effect of early pupil dilation after surgery on ocular hemodynamics in patients with diabetic retinopathy (DR) complicated with cataract, and to analyze the related factors affecting pupil diameter up to standard after dilation. Methods 150 patients with DR complicated with cataract who were treated in cataract surgery in our hospital ophthalmology from January 2018 to January 2022 were selected, the patients were evenly divided into control group and observation group by random number table method, two groups were given compound topicamide eye drops to dilate pupil after surgery, pupils were dilated once on 7d, and 14d after surgery in the control group, early pupil which beganing to dilate pupil once a day on the next day after surgery were dilated in the observation group. The changes and differences of ocular after surgery hemodynamics between the two groups were compared. According to whether the pupil diameter reaches the standard after pupil dilation on the 14th day after operation, the patients were divided into the standard group (pupil diameter ≥5mm) and the non-standard group (pupil diameter<5mm), clinical data of patients were collected, multivariate Logistic regression was used to analyze the factors affecting whether the pupil diameter reached the standard after pupil dilation. Results: The central retinal artery, short posterior ciliary artery end diastolic flow velocity (EDV) and peak systolic velocity (PSV) of the observation group increased 14d after surgery compared with 7d after surgery (P < 0.05), resistance index decreased compared with 7d after operation (P < 0.05), EDV and PSV of central retinal artery and short posterior ciliary artery were higher than those of control group at 7d and 14d after surgery (P < 0.05), RI was lower than that of control group (P < 0.05). The pupil dilation time of observation group on 14d after surgery was shorter than that on 7d after surgery (P < 0.05), the pupil diameter after pupil dilation increased compared with 7d after operation (P < 0.05), the pupil dilation time of the observation group was shorter than that of the control group on the 7d and 14d after operation (P < 0.05), and the pupil diameter after pupil dilation was larger than that of the control group (P < 0.05). The duration of diabetes > 10 years and the DR proliferative period were the risk factors affecting pupil diameter after pupil dilation (P < 0.05), and early postoperative dilation was a protective factor (P < 0.05). Conclusion In patients with cataract complicated with DR, early postoperative dilation can shorten the duration of pupil dilation of pupil, improve ocular hemodynamics, and increase pupil diameter after pupil dilation. The duration of diabetes, the severity of diabetic retinopathy and the timing of dilate pupils after surgery are the influencing factors of pupil diameter after pupil dilation.
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