三种非甾体抗炎药物在超声乳化白内障吸除联合人工晶状体植入术围手术期的应用研究

Clinical study of three non-steroidal anti-inflammatory drugs in the perioperative period of phacoemulsification surgery

目的探讨三种非甾体抗炎药物在超声乳化白内障吸除联合人工晶状体植入术围手术期的疗效。方法选取2018年7月至2019年1月于浙江大学医学院附属第二医院眼科就诊并行白内障手术的患者122例(122只眼)进行研究。其中,男性36例(36只眼),女性86例(86只眼);年龄50~85岁,平均年龄(68.2±10.2)岁。采用数字表法将患者随机分为A组、B组及C组。全部行超声乳化白内障吸除联合人工晶状体植入术,并在围手术期分别滴用0.1%普拉洛芬滴眼液、0.1%溴芬酸钠滴眼液及0.1%双氯芬酸钠滴眼液。患者年龄、超声乳化能量及有效超声乳化时间采用(x±s)描述,组间比较采用单因素方差分析。患者眼压、前房闪辉、角膜中央厚度、术后干眼情况及自觉症状评分采用(x±s)描述,组间比较采用两因素重复测量方差分析。术后自觉症状重度患者的发生率采用眼数和百分比表示,并进行χ^2检验。结果 A组、B组及C组患者的眼压,术前分别为(13.55±2.88)mmHg(1 mmHg=0.133 kPa)、(13.16±3.71)mmHg及(13.83±2.74)mmHg;术后1 d分别为(15.21±3.71)mmHg、(14.46±4.78)mmHg及(14.73±4.04)mmHg;术后7 d分别为(14.19±3.34)mmHg、(13.66±3.46)mmHg及(14.56±3.65)mmHg;术后30 d分别为(12.68±2.69)mmHg、(12.16±3.65)mmHg及(12.89±3.17)mmHg,三组患者术前、术后1 d、术后7 d及术后30 d的差异均无统计学意义(F=0.49,0.12,0.65,0.59;P>0.05)。A组、B组及C组患者的前房闪辉值,术前分别为(6.09±2.98)pc/ms、(6.81±2.93)pc/ms及(7.31±5.87)pc/ms;术后1 d分别为(13.04±6.92)pc/ms、(12.72±11.53)pc/ms及(14.22±11.31)pc/ms;术后7 d分别为(7.77±3.73)pc/ms、(6.99±4.19)pc/ms及(8.14±3.15)pc/ms;术后30 d分别为(7.06±3.72)pc/ms、(8.21±3.16)pc/ms及(9.29±4.97)pc/ms,三组患者术前、术后1 d、术后7 d及术后30 d的差异均无统计学意义(F=0.90,0.25,0.97,2.99;P>0.05)。A组、B组及C组患者的角膜中央厚度,术前分别为(536.05±30.07)μm、(537.08±30.08)μm及(523.14±38.65)μm;术后1 d分别为(628.91±84.20)μm、(674.94±154.43)μm及(619.02±144.65)μm;术后7 d分别为(550.59±38.64)μm、(553.14±35.43)μm及(543.31±45.51)μm;术后30 d分别为(539.93±33.98)μm、(549.27±34.14)μm及(527.78±78.74)μm,三组患者术前、术后1 d、术后7 d及术后30 d的差异均无统计学意义(F=2.22,2.02,0.64,1.45;P>0.05)。A组、B组及C组患者的泪河高度,术前分别为(0.18±0.08)mm、(0.21±0.11)mm及(0.22±0.09)mm;术后7 d分别为(0.19±0.08)mm、(0.19±0.08)mm及(0.25±0.15)mm;术后30 d分别为(0.22±0.11)mm、(0.23±0.12)mm及(0.24±0.15)mm,三组患者术后7 d的差异有统计学意义(F=4.97;P<0.05)。A组、B组及C组患者的自觉症状评分,术后7 d分别为(1.95±2.39)、(2.19±2.54)及(1.45±1.25)分;术后30 d分别为(2.33±2.03)、(1.73±2.02)及(1.51±2.02)分,三组患者术后7 d及术后30 d的差异无统计学意义(F=1.27,1.74;P>0.05)。A组、B组及C组患者的自觉症状评分≥3分(重度)者的占比,术后7 d分别为20.5%、38.9%及21.4%;术后30 d分别为38.6%、25.0%及16.7%,三组患者术后7 d及30 d的差异有统计学意义(χ^2=218.45,160.82;P<0.05)。结论三组非甾体类抗炎药物在白内障超声乳化手术围手术期应用的抗炎效果相同;C组药物对缓解白内障术后干眼的作用优于A组和B组。C组患者术后自觉症状评分优于其他两组。

Objective The aim of this study was to explore the effect of three non steroidal anti-inflammatory drugs in the perioperative period of phacoemulsification combined with intraocular lens implantation.Methods From July 2018 to January 2019,122 patients(122 eyes)with cataract surgery in Eye Center of the Second Affiliated Hospital,Zhejiang University Medical College were selected.Among them,36 cases(36 eyes)were male,86 cases(86 eyes)were female,and the average age was(68.2±10.2)years-old.The patients were randomly divided into A group,B group and C group.All patients were underwent phacoemulsification combined with intraocular lens implantation,and 0.1%pramiphene eye drops,0.1%sodium bromfenate eye drops and 0.1%diclofenac sodium eye drops were used in the perioperative period.The age,phacoemulsification energy and effective phacoemulsification time of patients were described by(x±s) and one-way ANOVA was used for comparison between groups.The scores of intraocular pressure,anterior chamber flash,central corneal thickness,postoperative dry eye condition and conscious symptoms were described by (x±s) and ANOVA.The incidence of severe postoperative symptoms was expressed by the number and percentage,and the chi-square test was performed.Results Intraocular pressure of all groups before operation were(13.55±2.88)mmHg(1 mmHg=0.133 kPa),(13.16±3.71)mmHg and(13.83±2.74)mmHg;1 d after operation,they were(15.21±3.71)mmHg,(14.46±4.78)mmHg and(14.73±4.04)mmHg,respectively;7 d after operation,they were(14.19±3.34)mmHg,(13.66±3.46)mmHg and(14.56±3.65)mmHg,respectively;30 d after operation,they were(12.68±2.69)mmHg,(12.16±3.65)mmHg and(12.89±3.17)mmHg,respectively.There was no significant difference among three groups before operation,1 d after operation,7 d after operation and 30 d after operation(F=0.49,0.12,0.65,0.59;P>0.05).All patients′anterior chamber flash value before operation were(6.09±2.98)pc/ms,(6.81±2.93)pc/ms and(7.31±5.87)pc/ms,respectively;1 d after operation,they were(13.04±6.92)pc/ms,(12.72±11.53)pc/ms and(14.22±11.31)pc/ms,respectively;7 d after operation,they were(7.77±3.73)pc/ms,(6.99±4.19)pc/ms and(8.14±3.15)pc/ms,respectively;30 d after operation,they were(7.06±3.72)pc/ms,(8.21±3.16)pc/ms and(9.29±4.97)pc/ms,respectively.There was no significant difference among three groups before operation,1 d,7 d and 30 d after operation(F=0.90,0.25,0.97,2.99;P>0.05).The central corneal thickness of all patients before operation were(536.05±30.07)μm,(537.08±30.08)μm and(523.14±38.65)μm,respectively;1 d after operation,they were(628.91±84.20)μm,(674.94±154.43)μm and(619.02±144.65)μm,and 7 d after operation,they were(550.59±38.64)μm,(553.14±35.43)μm and(543.31±45.51)μm,respectively;30 d after operation,they were(539.93±33.98)μm,(549.27±34.14)μm and(527.78±78.74)μm,respectively.There was no significant difference among three groups before operation,1 d,7 d and 30 d after operation(F=2.22,2.02,0.64,1.45;P>0.05).The height of lacrimal river in all groups before operation were(0.18±0.08)mm,(0.21±0.11)mm and(0.22±0.09)mm,respectively;7 d after operation,they were(0.19±0.08)mm,(0.19±0.08)mm and(0.25±0.15)mm,respectively;30 d after the operation,they were(0.22±0.11)mm,(0.23±0.12)mm and(0.24±0.15)mm,respectively.The difference of 7 d after operation was statistically significant(F=4.97,P<0.05).The scores of conscious symptoms in 3 groups 7 d after operation were(1.95±2.39),(2.19±2.54)and(1.45±1.25),respectively;30 d after operation,those were(2.33±2.03),(1.73±2.02)and(1.51±2.02),respectively.There was no significant difference between three groups in 7 d and 30 d after operation(F=1.27,1.74;P>0.05).The proportion of patients in 3 groups with severe(scores≥3),7 d after operation,20.5%,38.9%and 21.4%,respectively;30 d after operation,38.6%,25.0%and 16.7%,respectively.There was a significant difference between three groups in 7 d and 30 d after operation(χ~2=218.45,160.82;P<0.05).Conclusions Three groups of non steroidal anti-inflammatory drugs have the same anti-inflammatory effect in the perioperative period of cataract phacoemulsification;C group was better than others in relieving dry eyes after cataract surgery.The score of postoperative conscious symptoms in C group was better than other groups.