摘要：
目的 探讨不同玻璃体腔填充物对玻璃体切除术后20％甘露醇降眼压作用的影响.方法 回顾性病例对照研究.收集2016年1月至2017年1月于内蒙古科技大学包头医学院附属第一医院行玻璃体切除术的玻璃体出血患者,将术后高眼压的68例(72只眼)患者纳入研究,其中男性24例(26只眼),女性44例(46只眼);年龄(45.6±19.3)岁.根据术中不同玻璃体腔填充物分为硅油组23只眼、全氟丙烷(C3F8)组30只眼及平衡盐溶液(BBS)组19只眼.观察患者静脉滴注20％甘露醇前后不同时间点的眼压变化情况.采用t检验和方差分析与组间q检验进行统计学分析.结果 3个组患者用药后眼压均有明显下降,硅油组眼压在用药后75 min内下降达到谷值,从用药前(33.25±2.56)mmHg(1 mmHg=0.133 kPa)降至(23.21±1.85)mmHg,最大降幅达30.10％;B组在用药后75 min眼压下降到谷值,从(33.25±2.84)mmHg降至(12.15±1.12)mmHg,下降幅度为33.44％;C组在用药后45 min便降至最低,从(32.95±2.33)mmHg降至(17.50±1.35)mmHg,下降幅度为45.82％.3个组眼压差值在20、30、45、60 min经方差分析显示总体差异均有统计学意义(F=34.02,112.68,122.07,34.83;P=0.00),组间比较:平衡盐溶液组与硅油组对比差异有统计学意义(q=6.44,13.04,15.00,17.11;P=0.00);平衡盐溶液组与全氟丙烷组对比差异有统计学意义(q=7.68,12.56,12.93,13.61;P=0.00).结论 20％甘露醇对不同玻璃体腔填充物的玻璃体切除术后高眼压患者均有明显降眼压作用.用药后1h内玻璃体腔填充BSS患者的眼压下降最为明显和迅速;用药后75 min眼内填充BSS与硅油和惰性气体比较,眼压下降幅度无明显差异.%Objective To investigate the efficacy of 20％ mannitol in reducing intraocular pressure(IOP)in eyes with different intraocular tamponades after pars plana vitrectomy (PPV).Methods Retrospective case-control study.Sixty-eight patients were administered with 20％ mannitol and IOP was noted at regular intervals after simple PPV with ocular hypertension,including 24 males (26 eyes) and 44 females (46 eyes),aged (45.6± 19.3) years.These cases were divided into three groups according to different tamponades:silicon-oil tamponade,23 eyes;gas tamponade,30 eyes;balanced salt solution (BSS),19 eyes.The data were analyzed using the t test,variance and q test.Results There was a significant decrease in IOP in all patients after using 20％ mannitol.The IOP in the group of silicon-oil decreased from (33.25± 2.56) mmHg(1 mmHg=0.133 kPa) to (23.21 ± 1.85) mmHg,with a maximum decrease of 30.10％;the reduction in the group of C3Fs was from (33.25±2.84) mmHg to (12.15± 1.12) mmHg,with a maximum decrease of 33.44％.The IOP of the two groups dropped to a minimum both at 75 minutes.In the group of BSS,the IOP decreased from (32.95±2.33) mmHg to (17.50± 1.35) mmHg,and the maximum extent of the decrease was 45.82％ at 45 minutes.The difference in the IOP among the three groups at 20 min,30 min,45 min and 60 min was statistically significant (F=34.02,112.68,122.07,34.83,all P=0.00).There were significant differences between the BSS group and the silicone-oil group (q=6.44,13.04,15.00,17.11,all P=0.00),and between the BSS group and the C3F8 group (q=7.68,12.56,12.93,13.61,all P=0.00).Conclusion In eyes with different intraocular tamponades,20％ mannitol was useful for short-term IOP reduction after vitrectomy,especially in those with BSS within one hour.But after 75 minutes,there was no statistically significant difference between groups.
