劉暉，劉剛，羅莉麗

（四川省內(nèi)江市第一人民醫(yī)院眼科，四川 內(nèi)江 641000）

白內(nèi)障患者術(shù)后聯(lián)用激素和非甾體抗炎藥的臨床效果考察

劉暉，劉剛，羅莉麗

（四川省內(nèi)江市第一人民醫(yī)院眼科，四川 內(nèi)江 641000）

目的 研究白內(nèi)障患者術(shù)后應(yīng)用激素聯(lián)合非甾體抗炎藥治療的臨床效果。方法將200例白內(nèi)障患者隨機(jī)分為觀察組（妥布霉素地塞米松+普拉洛芬）和對(duì)照組（妥布霉素地塞米松），每組100例，觀察記錄患者圍治療期的各項(xiàng)癥狀和體征的評(píng)分及綜合評(píng)分。結(jié)果觀察組黃斑囊樣水腫發(fā)生率和前房閃輝評(píng)分明顯小于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），盡管觀察組患者的眼壓評(píng)分小于對(duì)照組，差異無統(tǒng)計(jì)學(xué)意義；此外在術(shù)后4 d和7 d時(shí)[(7.1±0.8)vs(8.3±0.9),(5.2±0.9)vs(6.6±0.7)]，觀察組綜合評(píng)分顯著低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05），而在術(shù)后14 d和30 d時(shí)[(3.2±0.7)vs(3.3±0.8),(1.1±0.5)vs(1.1±0.6)]，差異無統(tǒng)計(jì)學(xué)意義。結(jié)論白內(nèi)障患者術(shù)后聯(lián)用妥布霉素地塞米松和普拉洛芬可以有效地起到早期抗炎和緩解術(shù)后不良反應(yīng)的作用，具有良好的臨床應(yīng)用價(jià)值。

白內(nèi)障；激素類藥物；非甾體抗炎藥

白內(nèi)障在眼科治療中普遍使用的手術(shù)療法是超聲乳化聯(lián)合人工晶體植入術(shù)，但是該療法在治療過程中較易使前房發(fā)生不同程度的炎癥反應(yīng)[1]?，F(xiàn)階段白內(nèi)障患者術(shù)后抗炎的主要方法即為在患處進(jìn)行糖皮質(zhì)激素和非甾體抗炎藥的聯(lián)合給藥療法[2]，但是對(duì)于部分炎癥反應(yīng)較輕的患者能否進(jìn)行非激素類藥物給藥治療還有待于進(jìn)一步研究[3]。本文選取200例白內(nèi)障患者進(jìn)行了短期的糖皮質(zhì)激素和非甾體類抗炎藥聯(lián)合給藥，現(xiàn)將結(jié)果報(bào)道如下。

1 資料與方法

1.1 臨床資料 選取2015年1月～2016年6月在四川省內(nèi)江市第一人民醫(yī)院接受白內(nèi)障超聲乳化聯(lián)合人工晶體植入術(shù)治療的200例白內(nèi)障患者為治療對(duì)象，按隨機(jī)數(shù)字表將其分為對(duì)照組和觀察組，每組100例，對(duì)照組中有男71例，女29例，年齡51～85歲，平均（68.16±9.75）歲；觀察組中有男64例，女36例，年齡50～89歲，平均（71.35±8.69）歲。兩組臨床資料差異無統(tǒng)計(jì)學(xué)意義。所有治療對(duì)象的準(zhǔn)入標(biāo)準(zhǔn)為[4]：（1）年齡相關(guān)性白內(nèi)障患者；（2）眼壓在2.80 kPa以下；（3）診斷未見其他眼科前后節(jié)疾??；（4）無糖尿病病史；（5）無眼科手術(shù)病史；（6）術(shù)中未見并發(fā)癥；（7）簽署知情同意書。

1.2 方法 所有患者均由同一組醫(yī)護(hù)人員進(jìn)行同等的白內(nèi)障標(biāo)準(zhǔn)超聲乳化聯(lián)合人工晶體植入術(shù)進(jìn)行治療[5]，其術(shù)后的總療程均為1個(gè)月。其中對(duì)照組進(jìn)行常規(guī)白內(nèi)障術(shù)后給藥治療：即妥布霉素地塞米松滴眼液，6次/d，連續(xù)滴眼4 d，其后改為每天給藥3次；觀察組在進(jìn)行上述常規(guī)給藥的基礎(chǔ)上，同時(shí)聯(lián)用非甾體類抗炎藥普拉洛芬滴眼液給藥，6次/d，連續(xù)滴眼4 d，其后單用普拉洛芬進(jìn)行給藥，3次/d。

1.3 治療指標(biāo) 觀察記錄患者圍治療期的各項(xiàng)癥狀和體征變化并進(jìn)行評(píng)分，兩者相加可得綜合評(píng)分，觀察方法為在術(shù)后4 d、7 d、14 d和30 d分別觀察記錄患者癥狀和體征的治療情況，并檢查測量患者眼底和眼壓的改變情況，對(duì)其進(jìn)行評(píng)分的總體范圍為0～4分：無癥狀評(píng)0分，輕度癥狀評(píng)1分，中度癥狀評(píng)2分，重度癥狀評(píng)3分，極重癥狀評(píng)4分[6]。

1.4 統(tǒng)計(jì)學(xué)方法 本文實(shí)驗(yàn)數(shù)據(jù)均采用SPSS 19.0來處理，計(jì)量資料采用“±s”表示，組間比較采用t檢驗(yàn)；計(jì)數(shù)資料用“n，%”表示，組間比較采用χ2檢驗(yàn)，P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1 黃斑囊樣水腫 黃斑囊樣水腫患者在觀察組發(fā)現(xiàn)1例，對(duì)照組發(fā)現(xiàn)11例，差異有統(tǒng)計(jì)學(xué)意義（χ2=8.865，P＜0.05）。

2.2 前房閃輝評(píng)估 在術(shù)后各個(gè)檢查時(shí)間點(diǎn)，觀察組患者的前房閃輝評(píng)分?jǐn)?shù)據(jù)均明顯小于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.01）。見表1。

2.3 眼壓評(píng)估 在術(shù)后各個(gè)檢查時(shí)間點(diǎn)，觀察組患者的眼壓評(píng)分?jǐn)?shù)據(jù)均小于對(duì)照組，差異無統(tǒng)計(jì)學(xué)意義。見表2。

2.4 癥狀和體征的綜合評(píng)分比較 所有患者治療后的綜合評(píng)分均隨著治療時(shí)間的增加而降低，在術(shù)后4 d和7 d時(shí)，觀察組的綜合評(píng)分顯著低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05），而在術(shù)后14 d和30 d時(shí)，差異無統(tǒng)計(jì)學(xué)意義。見表3。

表1 兩組患者前房閃輝評(píng)分比較（±s，pc/ms）Table 1 The comparison between two groups about the scores of anterior chamber flare（±s，pc/ms）

表1 兩組患者前房閃輝評(píng)分比較（±s，pc/ms）Table 1 The comparison between two groups about the scores of anterior chamber flare（±s，pc/ms）

項(xiàng)目術(shù)后4 d術(shù)后7 d術(shù)后14 d術(shù)后30 d t值7.700 5.108 7.214 3.211觀察組(n=100) 6.3±3.1 6.4±2.7 5.6±2.4 5.5±2.3對(duì)照組(n=100) 9.9±3.5 8.5±3.1 8.1±2.5 6.5±2.1 P值＜0.01＜0.01＜0.01＜0.05

表2 兩組患者眼壓評(píng)分比較（±s，mmHg）Table 2 The comparison between two groups about the scores of intraocular pressure（±s，mmHg）

表2 兩組患者眼壓評(píng)分比較（±s，mmHg）Table 2 The comparison between two groups about the scores of intraocular pressure（±s，mmHg）

P值＞0.05＞0.05＞0.05＞0.05項(xiàng)目術(shù)后4 d術(shù)后7 d術(shù)后14 d術(shù)后30 d觀察組(n=100) 14.71±2.57 15.99±2.03 15.82±2.16 15.93±2.36對(duì)照組(n=100) 15.36±2.97 16.24±2.07 15.63±2.29 15.58±2.14 t值1.655 0.862 0.604 1.099

表3 兩組患者綜合評(píng)分比較（±s，分）Table 3 The comparison between two groups about the comprehensive scores（±s，score）

表3 兩組患者綜合評(píng)分比較（±s，分）Table 3 The comparison between two groups about the comprehensive scores（±s，score）

P值＜0.01＜0.01＞0.05＞0.05項(xiàng)目術(shù)后4 d術(shù)后7 d術(shù)后14 d術(shù)后30 d觀察組(n=100) 7.1±0.8 5.2±0.9 3.2±0.7 1.1±0.5對(duì)照組(n=100) 8.3±0.9 6.6±0.7 3.3±0.8 1.1±0.6 t值9.965 12.279 0.941 0

3 討論

白內(nèi)障患者術(shù)后炎癥反應(yīng)的常見影響因素源于手術(shù)操作導(dǎo)致的組織器官機(jī)械性損傷、超聲能量影響或晶體植入體內(nèi)后的異物反應(yīng)等[7]，由于物理化學(xué)因素會(huì)導(dǎo)致前列腺素分泌而對(duì)血液房水屏障造成影響和損壞，最終很容易誘發(fā)白內(nèi)障術(shù)后炎癥，同時(shí)蛋白會(huì)極易進(jìn)入房水內(nèi)而造成房水閃爍，房水中若出現(xiàn)炎癥細(xì)胞等細(xì)胞則會(huì)引起房水細(xì)胞反應(yīng)，由此可見對(duì)該病患者進(jìn)行術(shù)后給藥以控制炎癥的關(guān)鍵點(diǎn)為抑制患者前列腺素等細(xì)胞因子的作用[8]。一般來講，對(duì)此類患者在術(shù)后合理應(yīng)用抗炎藥物則能有效的消退炎癥反應(yīng)，進(jìn)而減輕或者治愈超聲乳化術(shù)后的前房反應(yīng)，該療法目前在臨床上已經(jīng)受到了廣大醫(yī)務(wù)工作者的普遍認(rèn)可[9]。

隨著超聲乳化手術(shù)的不斷發(fā)展完善，臨床上對(duì)于白內(nèi)障患者的術(shù)后炎癥反應(yīng)已經(jīng)相對(duì)大大減輕，因此對(duì)于該術(shù)式聯(lián)合人工晶體植入的患者可縮短糖皮質(zhì)激素的給藥療程至兩周以內(nèi)，對(duì)于術(shù)后未見炎癥反應(yīng)的患者可以不用糖皮質(zhì)激素藥物治療[10]。非甾體類抗炎藥在使用中雖可見一定程度的眼壓升高等不良反應(yīng)，作用效率不如激素類藥物迅速，但其在局部給藥時(shí)并不會(huì)明顯地?fù)p害患者眼角膜上皮細(xì)胞，且適應(yīng)癥更廣泛療效更良好，這就能很較好的彌補(bǔ)長期使用激素類藥物會(huì)產(chǎn)生藥物角膜毒性反應(yīng)的缺憾[11]。本文研究結(jié)果與上述文獻(xiàn)報(bào)道一致，在術(shù)后4天和7天時(shí)，觀察組綜合評(píng)分顯著低于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05），而在術(shù)后14天和30天時(shí)，差異無統(tǒng)計(jì)學(xué)意義。

綜上所述，白內(nèi)障患者術(shù)后聯(lián)用妥布霉素地塞米松和普拉洛芬可以有效地起到早期抗炎和緩解術(shù)后不良反應(yīng)的作用，具有良好的臨床應(yīng)用價(jià)值。

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Study of the clinical effect about the combination of the drugs hormonal and nonstemidal anti-imqammatory for patients with cataract after operation

Liu Hui,Liu Gang,Luo Li-li
(The First People’s Hospital of Neijiang,Neijiang,Sichuan,641000,China)

ObjectiveTo explore the clinical effect about the combination of the drugs hormonal and nonstemidal anti-imqammatory for patients with cataract after operation.MethodsTwo hundred patients with cataract received operation were divided randomly into the observation group which employed the combination of the drugs tobramycin dexamethasone and pranoprofen and the control group which employed tobramycin dexamethasone.Each group was containing 100 patients.The scores of every symptom,physical sign and general should be statistical record.ResultsAmong two hundred patients with cataract received operation,it is with significantly difference on the cystoid macular edema incidence rate and anterior chamber flare scores between the observation group and the control group,besides,the former numerical value is less than the latter(P＜0.05). There is no significantly difference on the intraocular pressure scores between the observation group and the control group although the former numerical value is also less than the latter.In additon,it is with significantly difference on the general scores between the observation group and the control group,besides,the former numerical value is less than the latter after four days and seven days for the operation[(6.3±3.1)vs(9.9±3.5),(6.4± 2.7)vs(8.5±3.1)](P＜0.05).There is no significantly difference on the general scores between the observation group and the control group although the former numerical value is also less than the latter after fourteen days and thirty days for the operation[(5.6±2.4)vs(8.1±2.5),(5.5±2.3)vs(6.5± 2.1)].Conclusion It is effective and valuable to resist inflammatory and adverse reaction with the combination of the drugs tobramycin dexamethasone and pranoprofen for patients with cataract after operation.

Cataract;Hormonal drugs;Nonstemidal anti-imqammatory drugs

10.3969/j.issn.1009-4393.2017.11.007