作者:王辉
【摘要】 目的 探讨挫伤性前房出血及其并发症对视功能的影响。方法 对127例挫伤性前房出血的并发症与合并症的发生及对视功能的损害进行回顾性分析。结果 挫伤性前房出血中男性明显多于女性(5∶1),以青少年及学生多见,其常见并发症是继发性青光眼(29.1%)与角膜血染(8.7%),而继发性青光眼的发生与前房出血的多少密切相关(P<0.0001);合并有眼部其他损伤者高达57.7%;入院与出院时的盲目率分别为65.5%和22.7%。结论 挫伤性前房出血可对视功能造成严重损害,主要是由其并发症及合并症所致。
关键词 眼外伤 前房出血 并发症 青光眼 角膜血染
A clinical analysis of contusion hyphema and its complications
Wang Hui
Department of Ophthalmology,Affiliated Hospiatl of Gannan Medical College,Jiangxi341000.
【Abstract】 Objective To study the effects of the contusion hyphema and its complications to the visual acuity. Methods The occurrence of the complications of contusion hyphema in127cases and its damage to visual acuity were retrospectively analyzed. Results The occurrence of contusion hyphema in male was obviously more than that in female(5∶1),especilly in youngsters and students. The common complications were secondary glaucoma(29.1%)and keratohemia(8.7%).The occurrence of secondary glaucoma had close interrelation with the bleeding amount of hyphema(P<0.0001).The percentage of the complications with other eye damages was as high as57.5%.The percentage of blindness at hospital admission and at hospital discharge was 65.5% and 22.7%respectively.Conclusion Contusion hyphema has aserious damage to visual acuity,which is chiefly caused by its complications.
Key words eye injury hyphema complication glaucoma keratohemia
眼球挫伤性前房出血是眼外伤中常见的临床表现之一,多数病例出血很快吸收,视力恢复正常。但出血多且持续较久者常发生一些并发症而影响视功能,严重者可致失明。现将我院自1993年以来收治的127例挫伤性前房出血病例分析报告如下。
1 临床资料
1.1 一般资料 本组127例中男106例(83.5%),女21例(16.5%),男∶女≈5∶1;右眼66例(52.0%),左眼61例(48.0%),均为单眼伤;年龄最小3岁,最大77岁,其中6岁以下14例(11.0%),7~20岁58例(45.7%),21~30岁24例(18.9%),31~40岁13例(10.2%),41~50岁10例(7.9%),51岁以上8例(6.3%),以青少年占多数;职业以学生为多,57例(44.9%),其次为农民24例(18.9%),工人21例(16.5%),其他职业计25例(19.7%)。
1.2 致伤原因 多种多样,以石、泥块击伤、弹弓伤、拳击伤及爆炸伤为多见。
1.3 分类与分级 挫伤性前房出血分原发性与继发性2 类,受伤后立即出现者为原发性前房出血,本组96例(75.6%),伤后2~5天出现者为继发性前房出血,本组31例(24.4%)。按Oksala分类法将前房出血分为Ⅰ级前房出血(少于1/3前房)、Ⅱ级前房出血(1/3~1/2前房)、Ⅲ级前房出血(多于1/2前房)[1]。本组病例中Ⅰ级41例(32.3%),Ⅱ级36例(28.3%),Ⅲ级50例(39.4%)。
1.4 并发症 继发性青光眼37例,占29.1%,其中发生在Ⅰ级前房出血中2例,Ⅱ级前房出血者中8例,Ⅲ级前房出血者中27例,以Ⅲ级前房出血者中继发青光眼的发生率最高(表1)。角膜血染11例,占8.7%,均发生于Ⅲ级前房出血者中。
表1 前房出血量与继发性青光眼的关系(略)注:χ2=27.49,P<0.0001
1.5 合并症 127例中合并眼部其他损伤者88例占69.3%,以外伤性瞳孔散大、房角后退、虹膜根部离断、晶体混浊与脱位、玻璃体积血及眼底出血、视网膜脱离为多见。
1.6 治疗 以半卧位休息,双眼包封,应用类固醇类药物及止血剂等治疗为主,对于继发青光眼者酌情选用降眼压药物治疗;对于前房出血量大,持续时间较久,伴眼压升高经保守治疗无效者,给予手术治疗;其他并发症与合并症进行相应的处理。本组行前房穿刺冲洗术29例,其中1例因反复出血,继发难以控制的高眼压而行眼球摘除。
1.7 结果 本组127例中有8例因年幼不合作而未测得视力,其余119例均测得入院与出院视力,见表2。
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