基層醫(yī)院老年白內(nèi)障患者超聲乳化術(shù)預后效果及并發(fā)癥危險因素分析

鐘啟文 李清云

[摘要] 目的 探究基層醫(yī)院老年白內(nèi)障患者行超聲乳化手術(shù)效果，并分析并發(fā)癥發(fā)病情況，從而為預防手術(shù)并發(fā)癥，提高手術(shù)效果提供科學的參考。 方法 該研究方便選擇2017年1月—2018年1月期間因白內(nèi)障入院接受超聲乳化手術(shù)的老年患者210例作為研究對象進行回顧性分析，記錄患者出現(xiàn)術(shù)中、術(shù)后出現(xiàn)并發(fā)癥的例數(shù)，并分析并發(fā)癥發(fā)生原因，通過病例篩選法，研究組為存在并發(fā)癥的老年白內(nèi)障患者43例（50只眼），對照組是隨機抽取未出現(xiàn)并發(fā)癥的60例患者（70只眼）。 結(jié)果 在基層醫(yī)院行超聲乳化手術(shù)并發(fā)癥主要包括后囊膜破裂、虹膜損傷、角膜內(nèi)皮水腫等；研究組患者術(shù)前視力低于0.1者（36.00%）高于對照組（15.71%），差異有統(tǒng)計學意義（χ2=6.549，P=0.01）；研究組患者光感-手動（26.0%）、數(shù)指（22.0%）高于對照組（8.57% 5.71%），差異均有統(tǒng)計學意義（P<0.05）；將術(shù)后是否出現(xiàn)并發(fā)癥作為作為因變量，多因素logistic回歸分析結(jié)果顯示冠心病（OR=2.609，P=0.037）、晶狀體核分級（OR=3.368，P=0.011）、術(shù)前視力（OR=2.431，P=0.016）、玻璃體手術(shù)史（OR=2.365，P=0.038）、切口靠前（OR=2.583，P=0.015）、后彈力層撕脫（OR=2.476，P=0.017）與白內(nèi)障超聲乳化手術(shù)并發(fā)癥呈相關(guān)性（P<0.05）。兩組患者術(shù)后最佳矯正視力對比，研究組患者術(shù)后1 d（t=3.979，P=0.0001）和術(shù)后1周視力（t=4.093，P=0.0001），均相對于對照組，差異有統(tǒng)計學意義（P<0.05）。 結(jié)論 針對基層醫(yī)院開展的老年白內(nèi)障患者白內(nèi)障超聲乳化術(shù)時，需要積極提升手術(shù)質(zhì)量、熟練掌握手術(shù)技巧，爭取零失誤。針對高危因素，采用多種途徑進行干預，減少術(shù)中、術(shù)后并發(fā)癥出現(xiàn)，促進術(shù)后視力恢復。

[關(guān)鍵詞] 白內(nèi)障；超聲乳化手術(shù)；基層醫(yī)院；并發(fā)癥

[中圖分類號] R779.66 [文獻標識碼] A [文章編號] 1674-0742（2019）02（b）-0037-04

Analysis of Prognosis and Risk Factors of Phacoemulsification in Elderly Patients with Cataract in Primary Hospitals

ZHONG Qi-wen， LI Qing-yun

Wuping County Hospital， Longyan， Fujian Province， 364300 China

[Abstract] Objective To investigate the effect of phacoemulsification in elderly patients with cataract in primary hospitals， and to analyze the incidence of complications， so as to provide a scientific reference for preventing surgical complications and improving the surgical results. Methods A total of 210 elderly patients who underwent phacoemulsification after cataract surgery from January 2017 to January 2018 were convenient retrospectively analyzed. The number of complications occurred during and after surgery was recorded. The causes of complications were analyzed. The case screening method was performed in 43 patients （50 eyes） with complication of elderly cataract. The control group was randomly selected from 60 patients （70 eyes） who had no complications. Results The complications of phacoemulsification in primary hospitals included posterior capsule rupture， iris injury， and corneal endothelial edema. The preoperative visual acuity of the study group was less than 0.1 （36.00%）， which was higher than that of the control group （15.71%）， with statistical significance （χ2=6.549， P=0.01）； light sensitivity-manual （26.0%） and number （22.0%） were higher in the study group than in the control group （8.57% 5.71%）， the difference was statistically significant （P<0.05）； whether the postoperative complications occurred as a dependent variable， multivariate logistic regression analysis showed coronary heart disease （OR=2.609， P=0.037）， lens nuclear grading （OR=3.368， P=0.011）， preoperative visual acuity （OR=2.431， P=0.016）， vitrectomy history （OR=2.365， P=0.038）， incision front （OR=2.583， P=0.015）， posterior elastic layer avulsion （OR=2.476， P=0.017） was associated with complication of phacoemulsification （P<0.05）. The best corrected visual acuity was compared between the two groups. One day after surgery （t=3.979， P=0.000 1） and one week postoperative visual acuity （t=4.093， P=0.000 1）， the difference was compared with the control group， being statistically significant （P<0.05）. Conclusion In the phacoemulsification of cataract patients with cataract in primary hospitals， it is necessary to actively improve the quality of surgery， master the surgical skills， and strive for zero mistakes. In response to high-risk factors， multiple interventions are used to reduce intraoperative and postoperative complications and to promote postoperative visual recovery.