糖尿病视网膜病变患者围手术期散瞳策略

目的：探讨糖尿病视网膜病变患者围手术期最佳散瞳方法,以利于玻璃体切割手术顺利进行。方法：回顾性分析我院2007年6月-2011年6月所有糖尿病视网膜病变患者的手术资料,选取术前常规应用复方托吡卡胺滴眼液、术中瞳孔直径≥7mm的患者手术时散瞳药的应用记录,共189例,204眼。术前点复方托吡卡胺滴眼液,每5min1次,共6次。点滴眼液后,0.5h内瞳孔散大（直径≥7mm）者为A组（78眼）;超过0.5h,但瞳孔散大时间在1h以内者为B组（75眼）;瞳孔散大时间大于1h者为C组（51眼）。B、C组于术前一天随机应用硫酸阿托品眼用凝胶或盐酸环喷托酯滴眼液,术前1h频点复方托吡卡胺滴眼液。结果：术中瞳孔直径能维持≥7mm的眼数比例,B、C组应用硫酸阿托品眼用凝胶者与应用盐酸环喷托酯滴眼液者差异均无统计学意义（P〉0.5）。术中有134眼因白内障同时行超声乳化白内障摘除术,其术中瞳孔直径能维持≥7mm的眼数比例,B组应用盐酸环喷托酯滴眼液者瞳孔维持的比例较用硫酸阿托品眼用凝胶者高（P〈0.5）,C组中二者比较差异无统计学意义（P〉0.5）。结论：对于术前单用复方托吡卡胺滴眼液散瞳时间超过0.5h者,术前点硫酸阿托品眼用凝胶或盐酸环喷托酯滴眼液有利于维持术中瞳孔大小,且二者效果差异无统计学意义。

Strategy for Mydriasis in Diabetes Retinopathy Patients during Perioperative Period

OBJECTIVE： To find the best method for mydriasis in patients with diabetes retinopathy （DRP） to promote the smoothly execution of vitreous body surgery. METHODS： The data of DRP patients in our hospital during Jun. 2007-Jun. 2011 were analyzed retrospectively. A total of 189 DRP patients, 204 eyes, receiving Compound tropicamide eye drops before operation and pupil diameter≥7 mm were collected to analyze the utilization of mydriatics. Compound tropicamide eye drops were given every 5 min for 6 times before operation. After treatment, patients with pupil dilated （diameter ≥7 mm） within 0.5 h were included in group A （78 eyes）; patients whose pupil were dilated more than 0.5 h but within 1 h were included in group B （75 eyes）; patients whose pupil were dilated more than 1 h were group C （51 eyes）. Group B and C were randomly given Atropine sulfate eye gel or Cyclopentolate hydrochloride eye drops, and given Compound tropicamide eye drops frequently 1 h before operation. RESULTS： The proportion of pupil diameter≥7 mm had no statistical significance between group B and group C receiving Atropine sulfate eye gels or Cyclopentolate hydrochloride eye drops （P0.5）. 134 eyes underwent phacoemulsification for cataract surgery because of cataract, and the proportion of pupil diameter ≥7 mm in group B receiving Cyclopentolate hydrochloride eye drops was higher than receiving Atropine sulfate eye gels （P0.5）; there was no statistical significance in group C （P0.5）. CONCLUSION： For DRP patients receiving Compound tropicamide eye drops at lest for 0.5 h before operation, use of Atropine sulfate eye gel or Cyclopentolate hydrochloride eye drops before operation contributes to maintaining the diameter of pupil during operation. There is no statistical difference.