摘要
目的探讨山东省开展白内障复明手术的效果及其影响因素。方法回顾性系列病例研究。统计白内障手术上报系统中2013年1月至12月山东省17市上报的108 190例患者信息，记录其基本情况；术前检查；手术情况，包括手术日期、手术方式、术中并发症等；术后情况，包括手术裸眼视力、3日疗效评价、术后并发症等。变量资料采用Wilcoxon秩和检验，有序多分类资料采用单因素Logistic回归分析和多变量有序Logistic回归分析。结果108 190例患者接受了白内障复明手术，女性64 852例（59.9%）多于男性43 338例（40.1%）；71~80岁以上患者39 496例，所占比例最高，约36.5%，其次为61~70岁（33 711例，31.2%）和81岁以上患者（14 720例，13.6%）；术后矫正视力（中位数为0.60）比术前矫正视力（中位数为0.10）有较大提高，差异有统计学意义（Z=165.24，P〈0.01）；单因素Logistic回归分析显示，术前矫正视力≤0.1（OR=2.30，95%CI：0.59~1.07）、并发性和先天性白内障（OR=8.50，95%CI：1.34~2.94；OR=1.69，95%CI：0.22~0.83）、传统白内障囊外摘除手术方式（OR=1.99，95%CI：0.57~0.81）、术后3日并发症（OR=7.46，95%CI：1.77~2.25）等为影响白内障手术效果的危险因素，影响效果较强。多因素Logistic回归分析显示，糖尿病史（OR=1.79，95%CI：0.46~0.71）、高血压史（OR=3.49，95%CI：1.07~1.43）、术后并发症（OR=3.91，95%CI：1.53~1.20）、传统白内障囊外摘除手术方式（OR=1.54，95%CI：0.20~0.66）是影响手术效果的危险因素；低年龄段、男性（OR=0.82，95%CI：-0.28^-0.12）、术前眼压正常（OR=0.79，95%CI：-0.38^-0.10）、术前瞳孔状态正常（OR=0.42，95%CI：-1.17^-0.57）为白内障手术效果的保护因素。结论山东省白内障患者复明手术后视力状况有了明显改善，手术效果受多种因素影响，应重视对全身疾病的控制，并尽量选择现代白内障手术方式。
ObjectiveTo explore the efficacy and related risk factors on cataract surgery in Shandong province.
MethodsA total of 108 190 cataract surgeries which were reported from 17 cities of Shandong province during January 2013 to December were reviewed. The demographic information, preoperative examination, surgery related information （including date of surgery, surgical methods, and intraoperative complications）, and postoperative situations （naked eye visual acuity, curative efficacy after three days, and postoperative complications） were reviewed. Wilcoxon signed-ranks, univariate and orderly multivariate Logistic regression analysis were used according to nature of the data.
ResultsThere were 64 852 female patients （59.9 %） and 43 338 male patients （40.1%） in all 108 190 cases. About 36.5% patients （39 496 cases）, the highest proportion, were 71 to 80 years of age, 31.26% patients （33 711 cases） were 61 to 70 years old and 13.6% patients （14 720 cases） were over 81 years old. Visual acuity increased significantly after surgery （Z=165.24, P〈0.01）. Simple factor Logistic regression analysis showed that preoperative corrected visual acuity less than 0.1 （OR=2.30 95%CI： 0.59 to 1.07）, complications （OR=8.50,95% CI： 1.34 to 2.94）, congenital cataract （OR=1.69, 95%CI： 0.22 to 0.83）, extracapsular cataract extraction （OR=1.99, 95% CI：0.57 to 0.81）, postoperative complications in three days （OR=7.46, 95% CI：1.77 to 2.25） were predictors of worse outcome after cataract surgery. Multivariate logistic regression analysis showed that the efficacy of cataract surgery were influenced by history of diabetes （OR=1.79, 95% CI： 0.46 to 0.71）, history of hypertension （OR=3.49, 95% CI： 1.07-1.43）, postoperative complications in three days （OR=3.91, 95% CI： 1.53 to 1.20） and extracapsular cataract extraction （OR=1.54, 95% CI： 0.20 to 0.66）. Young male patients （OR=0.82, 95% CI：-0.28 to -0.12）, normal preoperative intraocular pressure （OR=0.79, 95%CI： -0.38 to -0.10） and pupil （OR=0.42, 95% CI：-1.17 to -0.57） were predictors of better outcome.
ConclusionsVisual acuity improved significantly after cataract surgery in Shandong province. The efficacy of cataract surgery was influenced by many factors. It is important to control systemic diseases and to choose modern operation method.
作者
吴慧
黄华东
毕宏生
蔡婉婷
安淑敏
李传播
Wu Hui Huang Huadong Bi Hongsheng Cai Wanting An Shumin Li Chuanbo(Ophthalmology Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Chin)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2016年第12期929-935,共7页
Chinese Journal of Ophthalmology
基金
山东省软科学研究计划项目（2011RKGB7047）
关键词
白内障摘除术
治疗结果
年龄因素
高血压
危险因素
Cataract extraction
Treatment outcome
Age factors
Hypertension
Risk Factors
作者简介
通信作者：毕宏生，Email：semeye@163.com
