【作者】 郑莎；

【导师】 谢汉平；

【作者基本信息】 第三军医大学 ， 眼科学， 2004， 硕士

【摘要】 目的 重度烧伤后眼组织受到广泛的损伤, 虽然积极治疗,预后仍差,是临床上常见的难治性眼病之一。本研究旨在通过回顾性分析,获得急性重度眼烧伤的相关临床资料,了解角膜修复情况、致盲情况、并发症发生情况,以明确急性重度眼烧伤治疗后的眼表恢复情况以及并发症的发生率,为临床选择手术方式、改善疗效以及评价重度眼烧伤的预后情况提供参考依据。方法 在重庆第三军医大学附属西南医院病案室获得1977年1月1日至2002年12月31日共计26年期间,该院急性重度眼烧伤住院病例135例(155眼),分为酸、碱、热3类。设计并逐份填写病例资料调查表。针对相关临床资料、角膜修复情况、致盲情况、并发症发生情况设计2个Excel统计表格;再根据烧伤类型,逐份将调查表中的信息填入表格。最后将Excel文件格式转换成SPSS格式,采用SPSS10.0计算机统计软件作数据处理。 结果 一、急性重度眼烧伤的临床特点:患者以男性为主(86.7%),女性较少(13.3%);中青年(20-40 岁)居多(80.6%)。在3种烧伤类型中,热烧伤最多(50.0%),酸烧伤最少(15.0%)。III、IV度眼烧伤患眼数在1977-1998年的22年间呈逐步增多趋势;自1999年以来,收治的重度眼烧伤总患眼数呈明显增多趋势,且烧伤程度有加重倾向。成年人首要的致伤原因是工伤(81.8%);未成年人首要致伤原因是意外事故(83.3%);未成年人中碱烧伤为首要致伤类型(61.1%)。在成年女性中,酸、热烧伤各占35.7%,与故意伤害及工伤有关。浓硫酸是首要酸性致伤物(75%);石灰是首要碱性致伤物(48%);铝水是首要热烧伤致伤物(53%)。二、常见致伤物的致伤危害:在本研究中,在酸、碱、热3种不同烧伤类型作用下所致的急性重度眼烧伤,其III度、IV度的频率分布基本相同。三、角膜修复情况:III度烧伤中,酸、碱、热3种烧伤类型之间的角膜修复时间存在显著性差别(P=0.043)。在眼酸烧伤中,角膜修复时间≤3周占23.0%,4-7周占38.5%,<WP=10>8-15周占38.5%;在眼碱烧伤中, 角膜修复时间≤3周占22.6%,4-7周占74.2%,8-15周占3.2%,眼酸烧伤的角膜修复时间显著长于眼碱烧伤(P=0.006);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜修复时间无显著性差别。IV度烧伤中:酸、碱、热3种烧伤类型的角膜修复率分别为:酸:22.2%、碱:72.7%、热:42.9%,有显著性差异(P=0.018);其中眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤(P=0.017)和眼热烧伤(P=0.028);眼酸、热烧伤之间的角膜修复率无显著性差异。眼碱烧伤的角膜修复率分别显著性高于眼酸烧伤和眼热烧伤的原因分析:眼酸烧伤9眼、眼碱烧伤22眼、眼热烧伤35眼中,眼酸烧伤的睑外翻发生率为44.4%,角膜穿孔发生率为66.7%,显著性高于碱烧伤中睑外翻(4.5%) (P=0.017)和角膜穿孔(9.1%) (P=0.003)的发生率;眼碱烧伤和眼热烧伤各种相关并发症的发生率无显著性差别。在IV度烧伤中,3种烧伤类型之间的角膜修复时间无显著性差别。3种烧伤类型之间的角膜未修复原因分布存在显著性差别(P=0.040);在眼酸烧伤角膜未修复患眼中,14.3%由于发生了角膜溶解溃疡,85.7%由于发生了角膜穿孔,在眼碱烧伤角膜未修复患眼中,83.3%由于发生了角膜溶解溃疡,16.7%由于发生了角膜穿孔,即在IV度眼烧伤角膜未修复眼中,酸烧伤角膜穿孔的发生率显著性高于碱烧伤 (P=0.029);眼碱、热烧伤之间以及眼酸、热烧伤之间角膜未修复原因分布无显著性差别。III、IV度眼烧伤之间修复情况的比较:III度的角膜修复率为:酸:86.7%;碱:96.9%;热:90.5%;总体:92.1%。IV度的角膜修复率为:酸:22.2%;碱:72.7%;热:42.9%;总体:50.0%,在眼酸烧伤(P=0.003)、眼碱烧伤(P=0.029)、眼热烧伤(P<0.001)及重度眼烧伤总体(P<0.001)中,III度烧伤的角膜修复率均显著性高于IV度烧伤。III度眼烧伤的角膜修复时间显著短于IV度(P<0.001),在III度中,角膜修复时间≤3周占22.0%,4-7周占64.6%,8-15周占13.4%,在IV度中,角膜修复时间≤3周占3.0%,4-7周占9.1%,8-15周占87.9%。 四、致盲情况:155只重度烧伤眼的致盲率为75.5%;其中,78只重度化学烧伤眼的致盲率为66.7%, 77只重度热烧伤眼的致盲率为84.4%。“手术”特指以下眼表重建手术方式: LKP、PKP、眼睑缝合术、AMT、口唇粘膜移植术、结膜瓣遮盖术。手术眼平均随访时长为11.88±20.85月,其中III度为11.49±14.18月、IV度为12.04±23.17月;未手术眼平均随访时长为9.16±17.85月,其中III度为7.09±11.10月、IV度为14.16±27.84月。在以上随访时间条件下,未手术眼中,III度眼烧伤的致盲率(54.7%)显著低于IV度(100%)(P<0.001);在手术眼中,III度眼烧伤的致盲率(71.4%)显著低于IV度(100%)(P=0.011)。 <WP=11>五、并发症:IV度眼烧伤的睑球粘连发生率(59.1%)显著性高于III度(36.0%)(P=0.004); IV度眼烧伤的角膜穿孔发生率(27.3%)显著性高于III度(1.1%)(P<0.001);III度眼烧伤的角膜瘢痕发生率(65.2%)显著性高于IV度(28.8%)(P<0.001)。睑外翻在酸、碱、热3种眼烧伤类型中的发生率分别为:37.5%、11.1%、9.1%,眼酸烧伤的睑外翻发生率显著性高于眼碱烧伤(P=0.016)和眼热烧伤(P=0.003);眼酸烧伤的角膜穿孔发生率(29.2%)显著性高于眼碱烧伤(3.7%)(P=0.004);角膜瘢痕在酸、碱、热3种眼烧伤类型中的发生率分别为:29.2%、70.4%、4更多还原

【Abstract】 Purpose Even undergo positive treatments in clinic, acute severe injuries of the eye may produce extensive damages to the ocular surface epithelium and anterior segment, resulting in poor prognosis.Our study is to retrospectively analyse acute severe eye burns of 26 years and illuminate outcomes of corneal repairment, blindness and complications, so as to evaluate the prognosis and help to improve curative effect.Methods From 1977 to 2002, there were totally 135 cases 155 eyes with acute severe ocular chemical and thermal burns admitted to Southwest Hospital of Third Military Medical University, Chongqing. Divided them into acid, alkali, and thermal groups, firstly filled clinical details into designed questionnaires respectively. Secondly, made 2 Excel sheets according to outcomes of corneal repairment, blindness and complications, then transmitted information in those questionnaires into the sheets. Finally transformed Excel tables into SPSS ones and made statistical process.Results (1) Clinical characteristics of acute severe eye burns: 86.7%were male patients, 13.3% were females, and the greatest at-risk population were the 20-40 year old patients, accounting for 80.6%. Between acid, alkali, and thermal groups, thermal burns were the most usual causes, accounting for 50.0%, acid burns were the rarest causes, accounting for 15.0%. Grade III and IV injuries had gradually increased before 1999. However from 1999, the number of patients admitted have mounted up much more than the past years and the severity of burns tended to be aggravated. The principal cause of injuries for adults was work wounds (81.8%), and for minors it was contretemps(83.3%). Alkali was the principal type of burns among minors(61.1%). In female patients, acid and thermal burns accounted for 35.7% respectively, caused by purposive hurt as well as work wound. Oil of vitriol was the most primary injurants of acid burns(75%).Lime was the most primary injurants of alkali <WP=6>burns(48%). Melting aluminium was the most primary injurants of thermal burns(53%).(2) Harmness of common types of injurants in acute severe eye burns: In our study, acute severe eye burns caused by acid, alkali, or thermal were almost the same in distributing frequency of Grade III and Grade IV burns.(3) Corneal repair:In Grade III eye burns, there were significant differences of coreal repair time between acid, alkali, and thermal(P=0.043). In acid burns, the eyes whose corneal repair time≤3 weeks accounted for 23.0%, 4-7 weeks for 38.5%, 8-15 weeks for 38.5%. In alkali burns, ≤3 weeks accounted for 22.6%, 4-7 weeks for 74.2%, 8-15 weeks for 3.2%.That was to say, the corneal repair time of acid burns was significantly longer than alkali(P=0.006). Between not only alkali and thermal burns, but also acid and thermal burns there were no significant differences of corneal repair time.In Grade IV eye burns, there were significant differences of coreal repair incidence between acid(22.2%), alkali(72.7%), and thermal(42.9%)(P=0.018). The coreal repair incidence of alkali burns was significantly more than acid(P=0.017) and thermal burns(P=0.028).The corneal repair incidence showed no significant differences between acid and thermal burns. The reason why the coreal repair incidence of alkali burns was significantly more than acid and thermal burns was analysed as the following: among the 9 eyes of acid burns, the 22 eyes of alkali burns and the 35 eyes of thermal eyes, incidence of lid ectropion(44.4%) and corneal perforation(66.7%) in acid burns were both significantly more than those of alkali burns(lid ectropion: 4.5%, P=0.017; perforation 9.1%, P=0.003). Between alkali and thermal burns, no significant differences were showed in complications.In Grade IV eye burns, there were no significant differences of coreal repair time between acid, alkali, and thermal burns. There indicated significant differences of causes of coreal unrepair between the 3 groups of burns(P=0.040).In the Grade IV injuried eyes with unrepaired corneas, the incidence of corneal perforation(85.更多还原