摘要
目的探讨对老年心血管疾病患者进行白内障手术前综合因素评估的临床价值.方法回顾性分析近5年我科对218例（255只眼）老年心血管疾病患者施行白内障手术的相关临床资料.结果13例（14只眼）老年心血管疾病患者因术前评估发现手术禁忌证、无法耐受手术或手术后视力无法提高而放弃手术;205例（241只眼）老年心血管疾病患者安全施行白内障超声乳化或小切口白内障摘除联合人工晶状体植入术,其中56例有明显心脏疾病症状者经内科调整用药,在心电监护和持续低流量吸氧下施行手术.术后随访1～18个月（平均6.3个月）,术后最佳矫正视力：光感至＜0.05者8例（9只眼）,占3.9%;0.05至＜0.3者32例（39只眼）,占15.6%;≥0.3者165例（193只眼）,占80.5%.手术脱残率为78.1%,脱盲率为91.8%.手术中均无严重全身和局部并发症发生,达到预期效果,1例手术后因吸入性肺炎转入呼吸内科抢救治疗.结论老年心血管疾病患者施行白内障摘除联合人工晶状体植入术应加强术前综合因素评估,综合性医院应发挥其优势.对老年心血管疾病患者的围手术期处理,应严格掌握手术适应证和手术禁忌证;镇静类、肾上腺素类及糖皮质激素类药物的应用应个体化;特殊类型患者手术中采用心电监护和持续底流量吸氧,使手术风险降至最低;对于Ⅳ级及以上的晶状体核采用非超声乳化小切口白内障摘除联合人工晶状体植入术较白内障超声乳化联合人工晶状体植入术为佳.
Objective To evaluate the clinical results, the selection of time and procedures of surgery and preoperative evaluation of the phacoemulsification or small incision cataract surgery with intraocular lens implantation （PSI） in senile cataract patients with cardiovascular disease. Methods The authors performed a retrospective study in 218 senior patients （255 eyes） with cardiovascular disease, which were treated by PSI in the past 5 years. Results Thirteen cases （ 14 eyes） did not have PSI due to surgical contraindication or impossible to tolerate the operation or impossible to obtain an improvement of visual acuity after operation. Two hundred and five cases （241 eyes） with cardiovascular disease were treated with PSI. After follow up for 1 -18 months （mean 6.3 months）, 165 cases （193 eyes ） had a best corrected visual acuity （BCVA） equal or more than 20/60 （80.5%） ; 32 cases （39 eyes ） had BCVA of 20/400 or less than 20/60 （ 15.6% ） ; and 8 cases （9 eyes） had BCVA less than 20/400 （3.9%）. There were no severe complications during the operation. One case developed inhalation pneumonia postoperatively and was transferred to internal medicine for rescue. Conclusions Senile cataract patients with cardiovascular disease must be evaluated before performing PSI. The advantages of general hospital should be utilized to treat patients with cardiovascular disease before, during and after the operation. The use of sedatives, adrenalin and steroids must be individualized; high-risk patients should be monitored by EKG and supplied by constant inhalation of low dose oxygen to minimize the surgical risk. In senile cataract patients with cardiovascular disease and Ⅳ grade or more lens nucleus, small incision cataract surgery with intraocular lens implantation is better than phacoemulsitication with intraocular lens implantation. （Chin J Ophthalmol, 2006,42： 522-525）
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2006年第6期522-525,共4页
Chinese Journal of Ophthalmology
