本文選題：眼內(nèi)腎上腺素 + 視網(wǎng)膜管徑�。� 參考：《天津醫(yī)科大學(xué)》2013年博士論文

【摘要】：目的：本研究初步運(yùn)用視網(wǎng)膜圖像分析軟件,探討玻璃體切除術(shù)后視網(wǎng)膜管徑變化及眼內(nèi)灌注液中腎上腺素對(duì)視網(wǎng)膜管徑和黃斑厚度的影響,并采用兔眼氣體壓迫玻璃體切除術(shù),探討玻璃體腔內(nèi)相同濃度的腎上腺素對(duì)視網(wǎng)膜組織形態(tài)及視網(wǎng)膜功能的影響。 方法：第一部分：前瞻性設(shè)計(jì),選取屈光間質(zhì)清晰擬行玻璃體手術(shù)的黃斑裂孔病例為研究對(duì)象,共32例32眼,按照玻璃體灌注液含腎上腺素1：1000和不含腎上腺素隨機(jī)分為兩組。16眼為實(shí)驗(yàn)眼,16眼為對(duì)照眼。術(shù)前拍攝基線(xiàn)眼底照片和OCT檢查,兩組病例手術(shù)方法相同,均由同一經(jīng)驗(yàn)豐富術(shù)者進(jìn)行玻璃體切除手術(shù)。手術(shù)順利,無(wú)并發(fā)癥發(fā)生。術(shù)后隨診視力,裂隙燈眼底檢查,隨診第1月、第3月眼底照片和OCT檢查。眼底像標(biāo)準(zhǔn)同一像素下分別以視盤(pán)和黃斑為中心拍攝兩張眼底像。運(yùn)用ⅣAN視網(wǎng)膜圖像軟件,測(cè)量區(qū)域位于距視盤(pán)邊緣0.5～1.0視盤(pán)管徑范圍內(nèi),測(cè)量結(jié)果以視網(wǎng)膜中央動(dòng)脈等效管徑(CRAE)和視網(wǎng)膜中央靜脈等效管徑(CRVE)以及二者的比AVR來(lái)表示的。測(cè)量?jī)山M術(shù)后1個(gè)月視網(wǎng)膜黃斑厚度變化。第二部分：以10只新西蘭大白兔為研究對(duì)象,隨機(jī)分為2組,5只為實(shí)驗(yàn)組,5只為對(duì)照組。兩組兔的實(shí)驗(yàn)眼和對(duì)照眼玻璃體腔均注入0.4m1C3F8行氣體壓迫玻璃體切除術(shù),72小時(shí)后氣體膨脹達(dá)到最大體積時(shí),實(shí)驗(yàn)眼玻璃體腔注入0.1ml濃度1：1000的腎上腺素溶液,對(duì)照眼也采用相同的方法玻璃體腔注入0.1m1生理鹽水。所有兔在術(shù)前和術(shù)后一定時(shí)間給予裂隙燈、間接檢眼鏡檢查。分別于氣體玻璃體切除手術(shù)前、玻璃體腔注射后1、2、3周行兔眼彩色眼底照相、視網(wǎng)膜OCT、視網(wǎng)膜電圖(ERG)檢查,記錄a、b波振幅值。最后一次檢查后全麻下取兔視網(wǎng)膜標(biāo)本,光學(xué)顯微鏡觀察視網(wǎng)膜組織結(jié)構(gòu)變化,TUNEL染色觀察視網(wǎng)膜細(xì)胞凋亡變化。 結(jié)果：第一部分：觀察實(shí)驗(yàn)組和對(duì)照組16眼術(shù)后1月CRAE(170.88μm±5.17vs.182.84μm±46.63),CRVE(231.26gμm±19.37vs.231.59μm±52.23),比較無(wú)統(tǒng)計(jì)學(xué)上意義(P0.05)；術(shù)后3月CRAE(171.60μm±23.80vs.176.03μm±9.38),CRVE (226.35μm±19.10vs.226.80μm±19.23),比較無(wú)統(tǒng)計(jì)學(xué)上意義(P0.05)。觀察實(shí)驗(yàn)組和對(duì)照組16眼術(shù)后1月黃斑內(nèi)環(huán)厚度(292.11μm±29.96vs.273.25μm±13.82),雖然實(shí)驗(yàn)組較對(duì)照組增厚,但P=0.063,無(wú)明顯統(tǒng)計(jì)學(xué)意義。兩組玻璃體切除術(shù)后視力均大幅提高(P0.001),但實(shí)驗(yàn)組和對(duì)照組間視力無(wú)統(tǒng)計(jì)學(xué)意義。第二部分：實(shí)驗(yàn)組及對(duì)照組玻璃體腔注射1、2、3周后眼底觀察未見(jiàn)視網(wǎng)膜水腫、出血及脫離。實(shí)驗(yàn)組和對(duì)照組在玻璃體切除術(shù)前和玻璃體腔注射后各個(gè)時(shí)間點(diǎn)ERGa波、b波振幅總體差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組和對(duì)照組在玻璃體切除術(shù)前和玻璃體腔注射后各個(gè)時(shí)間點(diǎn)的OCT測(cè)量視網(wǎng)膜厚度數(shù)據(jù)未有統(tǒng)計(jì)學(xué)意義(P0.05)。第三周HE染色顯示兩組視網(wǎng)膜結(jié)構(gòu)未見(jiàn)明顯改變；TUNEL細(xì)胞凋亡染色顯示兩組均未見(jiàn)視網(wǎng)膜細(xì)胞凋亡。 結(jié)論：眼內(nèi)灌注液中1：1000的腎上腺素濃度對(duì)視網(wǎng)膜管徑變化和黃斑厚度沒(méi)有明顯影響,視網(wǎng)膜功能未受到進(jìn)一步損害；對(duì)兔眼視網(wǎng)膜電生理a波、b波振幅、OCT視網(wǎng)膜厚度無(wú)統(tǒng)計(jì)學(xué)意義上的變化,視網(wǎng)膜組織結(jié)構(gòu)未見(jiàn)到明顯組織損傷。本研究中,1：1000眼內(nèi)腎上腺素濃度沒(méi)有對(duì)視網(wǎng)膜造成損害。
[Abstract]:Objective: To investigate the changes of retinal tube diameter and the effect of adrenaline on retinal tube diameter and macular thickness in intraocular perfusion, and to explore the same concentration of adrenaline in the vitreous cavity with the same concentration in the vitreous body. The effect of state and function of the retina.
Methods: in the first part: prospective design, a total of 32 cases of macular holes in vitreous surgery were selected as the subjects. A total of 32 cases, 32 eyes were divided into two groups of.16 eyes and 16 eyes as the control eye. The baseline photo of the baseline and the OCT examination were taken before operation. The two groups of cases had the same surgical methods, all with the same experienced surgeon for vitrectomy. The operation was smooth and no complications occurred. Postoperative visual acuity, slit lamp fundus examination, first months of follow-up, third month fundus photo and OCT examination. Two fundus images were photographed with optic disc and macula in the same pixel as standard. Using the IV AN retina image software, the measurement area was located in the 0.5 to 1 disc diameter range from the rim of the optic disc. The results were measured by the equivalent diameter of the central retinal artery (CRAE) and the equivalent diameter of the central retinal vein (CRVE) and the ratio of two to the AVR. The retinal macular thickness changes in the two groups were measured in 1 months after operation. Second part: 1 0 New Zealand white rabbits were randomly divided into 2 groups, 5 experimental groups and 5 control groups. The two groups of rabbits' experimental and control eye glass cavity were injected with 0.4m1C3F8 gas compression vitrectomy, and when the gas expansion reached the maximum volume after 72 hours, 0.1ml concentration of 1:1000 was injected into the body cavity of the experimental eye. The control eye also used the same method to inject 0.1m1 saline into the vitreous cavity. All rabbits were given slit lights and indirect ophthalmoscope at a certain time before and after the operation. Before the vitrectomy, the rabbit eye color fundus photography, the retinal membrane OCT, the electroretinogram (ERG) examination, the A, b wave vibration were recorded before the vitreous vitrectomy. After the final examination, the rabbit retina specimens were taken under general anesthesia. The changes of retinal tissue structure were observed by optical microscope, and the apoptosis of retinal cells was observed by TUNEL staining.
Results: in the first part, the 16 eyes of the experimental group and the control group were observed after 16 eyes (170.88 mu m + 5.17vs.182.84 mu m + 46.63) and CRVE (231.26g m + 19.37vs.231.59 mu m + 52.23), and there was no statistical significance (P0.05), and the March CRAE (171.60 micron m + 9.38 9.38), and 226.35 mu (226.35 micron + 19.23), were not statistically significant. The thickness of the macular inner ring was observed in the experimental group and the control group after 16 eyes (292.11 mu m + 29.96vs.273.25 mu m + 13.82), although the experimental group was thicker than the control group, but P=0.063 had no significant statistical significance. The visual acuity of the two groups after vitrectomy increased significantly (P0.001), but the visual acuity between the experimental group and the control group was not statistically significant. The two part: the experimental group and the control group were injected with the vitreous cavity after 1,2,3 weeks. There was no retinal edema, bleeding and disengagement. There was no significant difference between the experimental group and the control group before and after the vitrectomy and the ERGa wave at each time point after the vitreous cavity injection (P0.05). The experimental group and the control group were before vitrectomy. The retinal thickness data were not statistically significant (P0.05) measured by OCT after intravitreal injection at each time point. Third weeks HE staining showed no significant changes in the two groups of retina structure, and TUNEL cell apoptosis staining showed that no retinal cell apoptosis was found in two groups.
Conclusion: the epinephrine concentration of 1:1000 in the intraocular perfusion has no significant influence on the changes of retinal canal diameter and macular thickness, and the retinal function is not further damaged. There is no significant change in the a wave of the retina, the amplitude of B wave and the thickness of the retina of the retina of the rabbit eyes, and the tissue structure of the retina has not seen obvious tissue damage. In this study, the concentration of 1:1000 epinephrine did not cause damage to the retina.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R774.1

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本文編號(hào)：1876109