慢性肾功能衰竭患者血液透析前后眼压和脉络膜厚度变化

Changes of intraocular pressure and choroidal thickness in patients with chronic renal failure after hemodialysis

目的:观察慢性肾功能衰竭患者血液透析前后眼压和脉络膜厚度的变化,探讨血透对患者眼部供血状态的影响。方法:选取长期在我院进行血透的慢性肾功能衰竭患者55例110眼,于血透前5min及血透后5min抽取静脉血检测血浆渗透压,及在血透前1h与血透后1h测量眼压,采用频域相干光断层扫描仪(OCT)的EDI深度扫描,比较血透前后眼压和脉络膜厚度。结果:慢性肾功能衰竭患者55例110眼血透后的血浆渗透压较血透前降低,差异有统计学意义(t=12.73,P<0.01);眼压较血透前明显升高,差异有统计学意义(t=2.07,P<0.05);血透后脉络膜厚度变薄,各测量点(中心凹下、距中心凹鼻侧及颞侧上方及下方1、3mm)与血透前比较,差异均有统计学意义(P<0.05)。结论:血透后慢性肾功能衰竭患者眼压升高,脉络膜厚度变薄,将影响眼部供血,提示对维持性血液透析患者透析时应调节渗透压梯度,加强眼部评估及检查,必要时给予相应的处理。

·AIM:To observe the changes of intraocular pressure and choroidal thickness after hemodialysis in patients with chronic renal failure,and to explore the impact of hemodialysis on blood supply.·METHODS:Totally 55 patients(110 eyes)with chronic renal failure who had been treated for a long time in our hospital were selected to test plasma osmotic pressure.Before and after hemodialysis 5min,hemodialysis venous blood was collected,and plasma osmotic pressure was measured.Before hemodialysis 1h and after hemodialysis 1h,intraocular pressure was measured;intraocular pressure and choroidal thickness were compared before and after hemodialysis measured by enhanced depth imaging technique of optical coherence tomography(OCT).·RESULTS:After hemodialysis plasma osmotic pressure reduced,and the difference was statistically significant(t=12.73,P<0.01);and intraocular pressure increased after hemodialysis and the difference was statistically significant(t=2.07,P<0.05).The choroid thickness was thinner after hemodialysis,and the differences before and after hemodialysis at every measurement points(under central fovea,nasal,temporal,superior and inferior 1 and 3mm from the central fovea)were statistically significant(P<0.05).·CONCLUSION:After hemodialysis ocular pressure increased and the choroid thickness became thinner in chronic renal failure patients,which might affect the ocular blood flow state.It is suggested that the osmotic pressure gradient should be adjusted in hemodialysis patients and eye test and treatment must be given in necessity.