白内障超声乳化术后主观症状和客观指标对患者满意度的影响

摘要

目的 探讨术后主观症状和客观指标对白内障超声乳化术后患者满意度的影响.方法 2016年1月至2017年6月共有35例老年白内障超声乳化术患者虽经成功手术、顺利恢复、术后视力明显改善,但术后3个月患者对手术效果仍不满意,将其设为不满意组(n=35).随机选择该时间段内年龄、性别、术前病情、术后视力改善程度相匹配,成功手术、顺利恢复且对手术效果满意的老年白内障超声乳化术患者35例作为对照,设为满意组(n=35).对比两组一般资料、术后视功能[视功能指数-14(VF-14)]、干眼主观症状[眼表疾病指数(OSDI)量表]、干眼客观指标[泪膜破裂时间(BUT)、泪液分泌试验(SehirmerⅠ)和角结膜荧光素染色(FI)]、焦虑水平[简式健康焦虑量表(SHAI)].单因素和多因素logistic回归分析影响患者术后满意度的预测因子.结果 两组患者年龄、性别等一般资料差异无统计学意义(P>0.05).单因素分析发现,术后VF-14(t=5.456,P<0.001)、OSDI(t=8.671,P<0.001)、BUT(t=2.187,P=0.032)和SHAI(t=3.611,P=0.001)与白内障超声乳化术后患者满意度具有显著的关联性(P<0.05),而FI、SehirmerⅠ与白内障超声乳化术后患者满意度无关(P>0.05).多因素logistic回归分析发现,只有VF-14、OSDI和SHAI是白内障超声乳化术后患者满意度的独立预测因子.结论 白内障超声乳化术后除了关注患者视力改善情况外,更应加强对患者视功能、干眼症状和心理状况等相关主观症状的评估.%Objective To investigate the influence of subjective symptoms and objective indexes on postoperative satisfaction of patients after phacoemulsification. Methods During the period from January 2016 to June 2017 in our hospital,a total of 35 cases of senile cataract patients accepted phacoemulsification were still dissatisfied with the postoperative outcome at 3 months after surgery,although underwent successful surgical procedure, smooth recovery,and enhanced visual acuity. These patients were collected as the dissatisfied group(n=35). The other series of 35 carefully selected patients with age-,sex-,preoperative disease indexs-,improved level of visual acuity- matched in the same period who were satisfied with the postoperative outcome after successful surgical procedure and smooth recovery,were randomly enrolled and defined as the satisfied group(n=35). The general information,postoperative visual function(visual function index-14,VF-14),subjective symptoms of dry eye(ocular surface disease index,OSDI),objective indexs of dry eye[tear break-up time(BUT),Schirmer test(SehirmerⅠ)and corneal fluorescein staining(FI)]and anxiety(shortened health anxiety inventory,SHAI)were evaluated between the 2 groups. Univariate and multivariate logistic regression analysis were used to predict the independent predictors of postoperative satisfaction. Results The general data including age,gender and other were no significant difference between the two groups(P>0.05). The univariate analysis showed that the postoperative indexs of VF-14(t=5.456,P<0.001),OSDI (t=8.671,P<0.001),BUT(t=2.187,P=0.032)and SHAI(t=3.611,P=0.001)were significant correlation with patient satisfaction(P<0.05). No significant correlations were found between FI or Sehirmer I and patient satisfaction(P>0.05). Multivariate logistic regression analysis showed that only VF-14,OSDI and SHAI were the independent predictors of patient satisfaction after phacoemulsification. Conclusion In addition to focusing on the improvement in visual acuity,more attention should be paid to the subjective symptoms such as visual function,dry eye symptoms and psychological status after cataract phacoemulsification.