增生型糖尿病视网膜病变患眼玻璃体切割手术联合硅油填充治疗后早期出血的相关影响因素分析

Analysis of factors on early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy

目的观察并分析增生型糖尿病视网膜病变(PDR)患眼玻璃体切割手术(PPV)联合硅油填充治疗后早期出血的相关因素。方法2014年1月至2017年5月在中日友好医院眼科首次行PPV联合硅油填充治疗的PDR合并牵拉性视网膜脱离和(或)玻璃体积血患者60例67只眼纳入研究。其中,男性34例,女性26例;平均年龄(51.3±12.5)岁。根据PPV联合硅油填充治疗后3 d内有无硅油下出血,将患眼分为无出血组、出血组;再根据出血分级将出血组分为少量出血组、大出血组。所有患眼均行标准经睫状体平坦部三通道25G或27G PPV联合硅油填充,其中联合超声乳化白内障吸除手术40只眼。手术后随访时间8~16 个月,平均随访时间(11.2±5.6)个月。对PPV联合硅油填充治疗后早期出血的可能影响因素进行回顾性分析。年龄、糖尿病(DM)病程、空腹血糖、糖化血红蛋白(HbA1c)、手术中血压行独立样本t检验;性别、是否伴发手术前虹膜新生血管(NVI)构成比比较行χ^2检验,样本量少于5时采用Fisher精确概率检验。结果60例67只眼中,无出血组、出血组分别为48例55只眼、12例12只眼。两组患者年龄(t=-3.552)、性别构成比、有高血压病史比较,差异有统计学意义(P=0.001、0.052、0.021);DM病程比较,差异无统计学意义(t=-0.451,P=0.654);HbA1c比较,差异有统计学意义(t=2.187,P=0.033);手术前存在NVI比较,差异有统计学意义(χ^2=6.414,P=0.011)。出血组12例12只眼中,少量出血组、大出血组分别为7例7只眼、5例5只眼。两组患者HbA1c分别为(7.8±1.1)%、(9.7±0.7)%,差异有统计学意义(t=-3.256,P=0.009);手术中收缩压分别为(153±18)、(186±7)mmHg(1 mmHg=0.133 kPa),差异有统计学意义(t=-3.894,P=0.003)。两组患者年龄(t=1.954)、性别构成、高血压病程(t=-1.787)、DM病程(t=-1.079)、空腹血糖(t=-0.361)、手术中舒张压(t=?0.811)比较,差异均无统计学意义(P>0.05)。结论影响PDR患眼PPV联合硅油填充治疗后早期出血的因素有年龄、高血压病史、手术前NVI和HbA1c水平;手术前较高HbA1c、手术中过高收缩压更容易引起手术后早期大量出血及继发性青光眼。

Objective To evaluate the factors that may influence the possibility of early hemorrhage after vitrectomy with silicon oil tamponade for proliferative diabetic retinopathy (PDR). Methods Sixty-seven eyes of 60 patients of PDR who received vitrectomy and silicon oil filled in Department of Ophthalmology, China-Japan Friendship Hospital during January 2014 and May 2017 were included in this study. There were 34 males and 26 females, with the mean age of 51.3 ± 12.5 years. Groups were divided depending on the degree of postoperative hemorrhage in 3 days: non-hemorrhage group (NH group) and hemorrhage Group (H group) composed of two sub-group that were called slight hemorrhage (SH) and massive hemorrhage (MH) group. The treatment was conventional 25G or 27G pars plana vitrectomy combined with silicon oil tamponade. Forty eyes received phacoemulsification. The follow-up ranged from 8 to 16 months, with the mean follow-up of 11.2±5.6 mon ths. The possible related factors of early hemorrhage after vitrectomy with silicon oil tamponade were analyzed. In dependent t test, X^2 test and Fisher test were used in this study. Results 55 eyes of 48 patients were in the NH group, while 12 eyes of 12 patients were in the H Group. There were statistical significances on the difference of age (t=-3.552, P=0.001), gender (P=0.052), hypertension (P=0.021), HbAlc (t=2.187, P=0.033) and presence of neovascularization of iris(X^2= 6.414, P=0.011), but there was no difference on diabetes duration (t=-0.451, P=0.654). Of the 12 patients in the H group, 7 were in the SH group and 5 were in the MH group. The MH group had a significantly higher HbAlc level (7.8± 1.1)% compared with the SH Group (9.7±0.7)%, the difference was statistical significant (t=-3.256, P=0.009). Higher systolic blood pressure of MH group 186 ±7 mmHg (1 mmHg=0.133 kPa) acquired during operation was observed compared with SH Group 153 ± 18 mmHg, the difference was statistical significant (t=-3.894, P=0.003). There was no statistical significances on the difference of age (t= 1.954), gender, hypertension duration (t=-1.787), diabetes duration (t=-1.079), fasting blood-glucose (t=-0.361), diastolic blood pressure during operation (t=-0.811) between the two groups (P>0.05). Conclusions Younger age, history of hypertension, presence of neovascularization of iris, higher level of HbAlc may predict greater possibility to cause early hemorrhage after vitrectomy w让h silicon oil tamponade for PDR. The patients with high level of HbAlc and high systolic pressure during the operation are more likely to undergo massive hemorrhage and secondary glaucoma.