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目的观察20G玻璃体切除术对高血压病患者泪膜稳定性的影响。设计前瞻性比较性病例系列。研究对象2013年7月至2014年2月在聊城市光明眼科医院行20G玻璃体切除术患者103例(103眼),其中伴高血压病者53例53眼(A组),无高血压病者50例50眼(B组)。均以对侧非手术眼作为对照。方法于术前1天,术后1、3、7天,1及3个月进行泪膜稳定性检测。主要指标基础泪液分泌试验(SIT)、泪膜破裂时间(BUT)、角膜荧光素染色(CFS)评分、干眼不适症状(DES)评分。结果与对照眼相比,A组患者术后1天、3天、7天术眼的DES评分高(Z=3.852、2.541、2.018,P=0.000、0.013、0.034)、BUT值短(t=4.073、4.521、3.545,P=0.000、0.000、0.008)、CFS评分高(Z=5.253、4.362、5.248,P均=0.000)、SIT值多(t=4.621、4.272、4.358,P均=0.000)。与对照眼相比,B组患者术后1天、3天、7天术眼的DES评分高(Z=4.324、3.263、2.432,P=0.000、0.002、0.018)、BUT值短(t=3.953、4.257、3.423,P=0.000、0.000、0.009)、CFS评分高(Z=5.221、4.305、5.253,P均=0.000)、SIT值多(t=4.257、4.238、4.137,P均=0.000)。与B组手术眼相比,A组术后1天、3天DES评分高(Z=3.726、2.357,P=0.000、0.018),术后1天、7天、1个月BUT值短(t=2.224、2.157、2.010,P=0.028、0.032、0.046),术后1天、3天、1个月CFS评分高(Z=3.589、3.317、2.794,P=0.000、0.008、0.029),术后3天、7天SIT值多(t=4.724、3.486,P均=0.000)。结论 20G玻璃体切除手术后早期,高血压病患者较非高血压病患者泪膜稳定性及泪液分泌量一过性下降,晚期可逐渐好转,恢复至正常。对高血压病患者术后早期应重视促进眼表恢复。
Objective To observe the effect of 20G vitrectomy on the tear film stability in patients with essential hypertension. Design prospective comparative case series. Participants 103 patients (103 eyes) with 20G vitrectomy were enrolled in Guangming Eye Hospital of Liaocheng from July 2013 to February 2014, 53 of 53 patients with hypertension (group A), hypertensive patients without hypertension 50 cases of 50 eyes (group B). Contralateral non-surgical eyes were used as a control. Methods The tear film stability was tested at 1 day before operation, at 1, 3, 7 days, 1 and 3 months after operation. The main indexes of basic tear secretion test (SIT), tear film break-up time (BUT), corneal fluorescein staining (CFS) score, dry eye discomfort symptoms (DES) score. Results Compared with the control eyes, the DES scores of the eyes of patients in group A at 1 day, 3 days and 7 days after surgery were significantly higher (Z = 3.852, 2.541, 2.018, P = 0.000, 0.013 and 0.034) P = 0.000,0.000,0.008), CFS score was higher (Z = 5.253,4.362,5.248, P = 0.000), SIT values were higher (t = 4.621,4.272,4.358, P = 0.000) . Compared with the control eyes, the B group had higher DES scores (Z = 4.324,3.263,2.432, P = 0.000,0.002,0.018) and shorter BUT values at 1, 3 and 7 days postoperatively (t = 3.953 , 4.257,3.423, P = 0.000,0.000,0.009). The CFS scores were high (Z = 5.221,4.305,5.253, P = 0.000) and the SIT values were higher (t = 4.257,4.238,4.137, P = 0.000). Compared with operation eye of group B, the score of DES in group A was significantly higher at 1 day and 3 days after operation (Z = 3.726, 2.357, P = 0.000 and 0.018), and the values of BUT at 1 day, 7 days and 1 month after operation were shorter = 2.224,2.157,2.010, P = 0.028,0.032,0.046). The CFS scores at 1 day, 3 days and 1 month after operation were significantly higher (Z = 3.589,3.317,2.794, P = 0.000,0.008,0.029) Three days, seven days more SIT values (t = 4.724,3.486, P = 0.000). Conclusion In the early stage of 20G vitrectomy, the stability of tear film and tear secretion in patients with essential hypertension are lower than those in non-hypertensive patients, and can be gradually improved in the later stage and returned to normal. Hypertensive patients should pay attention to promote early ocular surface recovery.