目的 探讨不同类型高度近视视网膜劈裂患者脉络膜特征及临床意义.方法 采用横断面研究.2019 年 1 月至 2022年 3 月于首都医科大学附属北京友谊医院眼科就诊的患者中,选取根据黄斑病变萎缩-牵拉-新生血管(atrophic,tractional,neovascular components,ATN)分型符合T0～T3 级高度近视患者 74 例 74 只眼纳入研究.其中,男性 20 例 20 只眼、女性 54例 54 只眼;平均年龄(64.3±11.2)岁;眼轴长度(axial length,AL)(29.2±2.78)mm.患者均行加强深度成像模式光学相干断层扫描.依据ATN分型将患者按照病变程度分为T0～T3 级,分别为 20、23、18、13 只眼.获取黄斑中心凹多个部位脉络膜厚度数据,采用MATLAB软件计算该区域的脉络膜容积(macular choroidal volume,MCV).参数间行相关性分析.组间差异比较采用单因素分析和多因素分析.结果 T0～T3组患者MCV分别为(4.6±2.3)mm3、(3.1±1.2)mm3、(2.9±1.3)mm3、(2.1±1.1)mm3,差异有统计学意义(P=0.006).与T0 组患者相比,T1～T3 组患者最佳矫正视力明显下降,AL和等效球镜绝对值明显增加,黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)明显下降,差异均有统计学意义(P＜0.05).T1 与T3组间及T2 与T3 组间等效球镜的差异,以及T1 与T2 组间及T1 与T3 组间SFCT和MCV的差异依赖AL和年龄,T2 和T3 组间SFCT和MCV的差异不依赖AL和年龄.结论 高度近视患者随着视网膜劈裂程度加重,MCV逐步下降,MCV的变化受到AL、年龄等多种因素影响.

Objective:To observe the changes of optic disc structure in patients with high myopia and the correlation with the morphological markers of the fundus.Methods:A retrospective study. From July 2018 to January 2020, 90 patients (155 eyes) diagnosed as high myopia in Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University were included in the study. Among them, there were 31 males (52 eyes) and 59 females (103 eyes), with age of 57.1±14.2 years old and axial length (AL) of 28.5±2.6 mm. According to the classification of myopic macular degeneration, patients were divided into 4 groups based on forms and degree of lesions, including non-pathological myopia group, mild traction lesions group, severe traction lesions group and neovascular lesions group, 35, 58, 41, 21 eyes, respectively. The digitized fundus photographs and an Image J system were used to measure the horizontal, vertical, maximal, and minimal diameter of the optic disc, the horizontal and vertical diameter of the parapapillary δ zone and γ zone, ovality index, distance between the most superior point of the temporal superior arterial arcade and most inferior point of the temporal inferior arterial arcade (VDA), angle between the temporal arterial arcade and optic disc (angle kappa), distance between the optic disc center and the fovea (DFD), angle between the horizontal disc axis and the disc-fovea line (DFA). The correlation between the diameter of the optic disc and other parameters was analyzed. Univariate and multivariate analysis were used to compare differences between groups.Results:The horizontal diameter of the optic disc was positively correlated with the horizontal diameter of the δ zone ( r=0.300, P<0.001), Kappa angle ( r=0.260, P=0.003), and elliptic index ( r=0.650, P<0.001); it was negatively correlated with DFD ( r=-0.190, P=0.030). Optic disc vertical diameter and optic disc horizontal diameter ( r=0.280), δ-zone horizontal diameter ( r=0.330) and vertical diameter ( r=0.460), γ-zone horizontal diameter ( r=0.430) and vertical diameter ( r=0.390), DFD ( r=0.390) was positively correlated ( P<0.001); it was negatively correlated with DFA ( r=-0.210, P=0.001) and Kappa angle ( r=-0.210, P=0.004). Compared with the non-pathological myopia group, there were statistically significant differences in the horizontal and vertical diameters of the optic disc in the severe traction disease group ( P<0.05). Among them, the horizontal diameter difference did not depend on the eye axis and age difference; the vertical diameter difference was caused by the eye axis difference. Compared with the non-pathological myopia group, the difference in the horizontal diameter of the optic disc in the neovascular disease group was statistically significant ( P<0.05), and did not depend on the difference in the axis and age; the difference in the vertical diameter of the optic disc was not statistically significant ( P>0.05). Conclusion:The morphology of optic disc was related to several fundus morphological markers, which was differentiated according to the age, AL and the degree of disease in patients with high myopia.

目的 观察玻璃体腔内注射雷珠单抗(IVR)治疗病理性近视脉络膜新生血管(mCNV)的有效性与安全性,同时观察患者黄斑中心凹下脉络膜厚度变化.方法 回顾性病例系列研究.将2014年11月至2018年12月诊断为初发活动期mCNV并接受IVR的38例42眼纳入研究.所有患者采取IVR 1针初始治疗联合按需注射(1+PRN)的治疗方案,按照患者随访结束时接受IVR的治疗次数分为单次治疗组与重复治疗组两组.观察两组术前及随访结束时研究对象最佳矫正视力、黄斑中心凹下方脉络膜厚度等方面的差异.结果 重复治疗组雷珠单抗注射次数(3.77±1.21)次,单次治疗组基线脉络膜厚度(59.15±10.57)μm,重复治疗组基线脉络膜厚度(49.33±12.76)μm,二者比较差异有统计学意义(P=0.023);重复治疗组重复治疗前脉络膜厚度增加至(55.22±7.63)μm,重复治疗组基线脉络膜厚度与重复治疗前脉络膜厚度无统计学差异(P=0.131).结论 雷珠单抗玻璃体腔内注射1+PRN的治疗方案可有效的治疗病理性近视脉络膜新生血管.基线脉络膜厚度更薄的患者需要重复治疗的可能性更大.

目前,脑梗死是造成世界人口死亡和残疾的首位原因,现约有1824.7万缺血性脑卒中(IS)患者,每年约有72.6万新发脑梗死患者[1].然而,关于脑梗死急性期给予抗凝治疗是否合理以及抗凝治疗的具体使用等问题,迄今尚无统一的定论[2].在2016年ESC以及2018年欧洲心律协会关于心房颤动(房颤)患者的管理指南中,对于脑梗死患者抗凝治疗的启动时间均推荐"1-3-6-12原则".即短暂性脑缺血发作(TIA)患者发病后1 d可抗凝治疗,轻型[美国国立卫生研究院卒中量表(NIHSS)评分＜8分)]非致残性脑卒中发病3 d后可抗凝治疗,中型脑卒中(NIHSS评分8～15分)发病6 d后可抗凝治疗,重型脑卒中(NIHSS评分≥16分)发病12 d后结合复查头颅MRI或CT结果酌情考虑抗凝治疗[3].目前中国脑梗死诊治指南2018也未对脑梗死急性期抗凝治疗的具体时间和方法做出明确规定,仅提到对于少数患者抗凝治疗[4].本综述就近年来关于急性脑梗死抗凝治疗的研究进展,主要围绕以下3个方面进行阐述:(1)关于急性脑梗死抗凝治疗药物的选择问题.(2)关于急性脑梗死发病后启动抗凝治疗的时间问题.(3)关于选择特殊亚组患者进行个体化抗凝治疗的问题.

报告一例陈旧性视网膜中央静脉阻塞6年后发生视网膜中央动脉阻塞的病例,讨论视网膜血管阻塞性疾病全身治疗的重要性.

目的 采用频域光学相干断层扫描(SD-OCT)的增强深度成像(EDI)技术分析视网膜中央动脉阻塞(CRAO)眼各项脉络膜结构相关参数的改变.方法 收集2018年10月至2019年12月在首都医科大学附属北京友谊医院眼科确诊为CRAO的21例单眼患者临床资料.选取CRVO患眼及对侧健眼各项脉络膜结构相关参数测量结果进行分析并比较,包括脉络膜总面积(total choroidal area,TCA)、脉络膜血管面积(luminal area,LA)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)及脉络膜血管指数(choroidal vascularity index,CVI).结果 CRAO患者患眼SFCT、TCA、LA和CVI分别为(210.95±36.43) μm、(1.01±0.27) mm2、(0.64±0.18) mm2、(63.52±3.11)％,对侧健眼分别为(293.33±57.99) μm、(1.40±0.24) mm2、(0.93±0.16) mm2、(66.76±3.93)％.21眼CRAO患眼与对侧健眼相比,SFCT变薄,TCA、LA、CVI下降,差异均有统计学意义(均为P＜0.05).结论 CRAO眼脉络膜的形态结构发生改变,SFCT变薄,CVI减小,提示CRAO发生时除存在视网膜缺血外还伴有脉络膜供血不足.

目的 比较近视患者接受准分子激光原位角膜磨镶术(LASIK)术后早期佩戴2种硅水凝胶角膜接触镜的上皮修复、术后并发症及眼部不适症状.方法 前瞻性选取2019年4月至10月于首都医科大学附属北京友谊医院行LASIK手术的近视患者35例(70眼),采用自身对照,LASIK术后随机给予35眼配戴Lotrafilcon A角膜接触镜,对侧眼配戴Balafilcon A角膜接触镜.术后1 d取出,分别记录术后1、3、7 d的不适症状(疼痛感、干涩和流泪)发生率、术后并发症发生率及角膜荧光素染色(FL)阳性率.对双眼间各项指标进行统计学分析.结果 在术后1 d,Lotrafilcon A组无症状率高于Balafilcon A组(77.14％vs.54.29％),差异有统计学意义(P<0.05),在术后3、7 d组间无症状率比较,差异无统计学意义(85.71％vs.80.00％,88.57％vs.91.43％).Lotrafilcon A组与Balafilcon A组的术后角膜瓣移位皱褶、角膜瓣边缘瘢痕、层间炎症反应等并发症发生率比较(2.86％vs.0,2.86％vs.8.57％,2.86％vs.0),差异无统计学意义(P>0.05).在术后1 d,Lotrafilcon A组FL阳性率低于Balafilcon A组(17.14％vs.40.00％),差异有统计学意义(P<0.05),在术后3、7 d组间FL阳性率比较(11.43％vs.14.29％,5.71％vs.8.57％),差异无统计学意义(P>0.05).结论 硅水凝胶角膜接触镜对于缓解眼表刺激症状、促进角膜愈合有显著疗效,适宜于近视患者LASIK术后早期配戴.Lotrafilcon A以及Balafilcon A角膜接触镜在LASIK术后应用是安全有效的,Lotrafilcon A更有助于角膜上皮再生.

目的 构建科学、实用的手术患者术前压力性损伤风险评估指标.方法 通过研究文献、专家会议,运用Delphi法开展两轮专家咨询,确定风险因素评估指标.结果 咨询来自手术室护理、伤口护理、护理管理、科研等领域的12名专家,两轮专家咨询后问卷有效回收率为100％,专家权威系数为0.96.最终确立手术患者术前压力性损伤风险评估指标共8项.结论 构建手术患者术前压力性损伤风险评估指标具有科学性、全面性及临床便捷性,为制订预防措施提供依据.

目的 观察糖尿病黄斑水肿(diabetic macular edema,DME)患者接受康柏西普单次玻璃体内注射治疗后黄斑形态与功能的恢复情况.方法 回顾性分析23例(25眼)DME患者临床资料.按照是否接受康柏西普玻璃体内注射治疗分为治疗组和对照组.观察并比较两组患者观察起点与终点(治疗组术前与术后1个月比较,对照组入组与随访观察1个月比较)最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹视网膜厚度(central retinal thickness,CRT)和微视野计检测的视网膜光敏感度等.结果 治疗组观察起点CRT为(448.73±193.25)μm,观察终点CRT为(300.60±74.93)μm,二者比较差异有统计学意义(t=2.768,P=0.010).所有患者经康柏西普玻璃体内注射治疗后均无手术并发症发生.所有研究对象4°内注视点均>75％,治疗组和对照组4°与8°的视野视网膜光敏感度观察终点与观察起点比较差异均无统计学意义(均为P>0.05),两组间4°与8°视野视网膜光敏感度在观察起点及观察终点比较差异均无统计学意义(均为P>0.05);两组12°平均视网膜光敏感度比较差异有统计学意义(P=0.011).结论 玻璃体内单次注射康柏西普治疗DME安全有效,能够有效地减轻黄斑水肿及提高视力,形态学恢复早于功能学恢复.

AIM: To investigate the differences of the choroidal vascularity index between type 2 diabetes with diabetic retinopathy and non-diabetes patients.METHODS: A retrospective cross-sectional study was performed at Beijing Friendship Hospital. Enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT)scans of 68 eyes of 68 type 2 diabetes who with diabetic retinopathy were compared with those of right eyes of 34 age- and gender-matched healthy controls. The choroidal images were binarized into luminal areas(LA)and stromal areas(SA). CVI was defined as the ratio of LA to total circumscribed subfoveal choroidal area. Mean choroidal thickness, mean retinal thickness and mean CVI between patients and controls were compared using t-test. RESULTS: There were no significant differences in total circumscribed subfoveal choroidal area(0.53±0.14mm2 vs 0.49±0.15mm2), LA(0.35±0.09mm2 vs 0.32±0.10mm2), SA(0.17±0.05mm2 vs 0.17±0.06mm2), or subfoveal choroidal thickness(347.9±76.9μm vs 325.9±92.9μm)between patients with DR and controls(P>0.05). However, there was a significantly lower CVI in patients with diabetes as compared to controls(64.33%±3.25% vs 67.04%±2.46%, P<0.001). The critical value was 63.59%.CONCLUSION: CVI is a kind of biological indicators which can directly reflect the changes of choroidal internal structure, and it is more stable and reliable than SFCT. For type 2 diabetic patients who with diabetic retinopathy, CVI is lower than that of healthy people.

目的 探讨早期非动脉炎性前部缺血性视神经病变(NAION)患者的血管管径、血流量及血流动力学改变.方法 选择2017年7月至2019年1月在北京友谊医院眼科确诊为NAION的患者30例(30只眼)作为研究组,对照组选取无NAION者30例(30眼),均进行计算机断层扫描血管造影检查,测定眼动脉直径以及颈内动脉虹吸部直径;均进行彩色多普勒超声检查,测定眼动脉平均血流速度、颈内动脉虹吸部平均血流速度以及睫状后短动脉收缩期血流峰值、舒张期血流峰值、阻力指数.计算出眼动脉及颈内动脉虹吸部血流量.比较分析两组指标并对阳性指标行ROC曲线分析.结果 研究组的颈内动脉虹吸部直径、眼动脉及颈内动脉虹吸部血流量以及睫状后短动脉收缩期血流峰值和舒张期血流峰值均明显低于对照组(P<0.05),而眼动脉直径、眼动脉及颈内动脉虹吸部平均血流速度以及睫状后短动脉阻力指数与对照组比较,差异无统计学意义(P>0.05).ROC曲线显示睫状后短动脉收缩期血流峰值、颈内动脉虹吸部血流量、睫状后短动脉舒张期血流峰值以及颈内动脉虹吸部直径对于早期NAION有较高诊断价值.结论 颈内动脉虹吸部狭窄、血流量下降以及睫状后短动脉血流速度下降时更易发生NAION.

目的 观察曲安奈德(triamcinolone acetonide,TA)球侧及上穹隆部注射治疗中重度活动期甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)的疗效与并发症.设计回顾性病例系列.研究对象北京友谊医院中重度活动期TAO患者34例(60眼).方法 回顾患者的病历资料.所有患者采用眼球侧注射TA(20～40 mg).其中上睑退缩≥2 mm者联合上睑穹隆部注射TA(20 mg).首次治疗后1周复查,此后每月复查,如症状改善,每月重复注射1次.当上睑位置降至正常或与对侧健眼一致, 眼睑、结膜充血水肿、复视消退时停药.观察随访至少3个月,平均随访(9.12±5.28)个月.主要指标临床活动性评分(clinical activity score,CAS)、甲状腺眼病生活质量量表(quality of life in thyroid eye disease,TED-QOL)评分,上睑缘距角膜映光点距离(marginal reflex distance,MRD1)、眼球突出度、最佳矫正视力、眼压、B超眼外肌直径.结果 治疗前及最后随访时比较,CAS评分分别为(3.79±0.81)、(1.29±0.68) (P=0.000);TED-QOL量表评分分别为(17.85±2.80)、(10.18±3.02) (P=0.000);MRD1分别为(6.29±0.68)、(4.56±0.71) (P=0.000);眼球突出度分别为(18.20±2.77)mm、(17.65±2.90)mm (P=0.000);上、下、内、外直肌直径分别为(2.34±0.67、3.62±1.06、3.06±0.67、2.71±0.79)mm,(2.15±0.50、3.30±0.99、2.81±0.61、2.51±0.61)mm(P均＜0.05);最佳矫正视力(LogMAR)分别为(4.99±0.12)、(4.99±0.16)(P=0.289);眼压分别为(16.65±2.91)mmHg、(16.78±4.30)mmHg(P=0.772).上睑退缩者球侧注射联合上穹隆注射组较单纯球侧注射组的上睑退缩程度治疗前后差异分别为(1.15±0.38)mm、(2.31±0.48)mm(P=0.000);两组眼球突出度前后差异分别为(-0.69±0.75)、(-0.84± 1.28)mm(P=0.712);两组治疗前后上、下、内、外直肌直径差分别为(0.22±0.52,0.28±0.49)mm,(0.32±0.56,0.51±0.76)mm、(0.35±0.40,0.34±0.49)mm,(0.23±0.56,0.47±0.84)mm(P均＞0.05).治疗后眼压升高＞21 mmHg者9/60眼(15％).治疗后月经改变2例.结论 40 mgTA眶周注射可有效降低活动期TAO眶部的炎性反应.球侧及上穹隆部联合注射较单纯球侧注射对上睑退缩改善更明显.治疗同时要注意眼压升高等并发症.

1 资料与方法 患者女性,29岁,以"恶心、呕吐1个月余,进食困难伴饮水呛咳半月,呼吸困难5 d,发热1 d"主诉收入北京世纪坛医院.患者病史长且复杂,笔者根据其先后就诊医院对其病史进行总结(表1).2018年5月10日患者在北京西客站候车过程中出现呼吸困难加重,随后出现呼之不应,立即送至本院急诊.至本院急诊抢救室时,患者生命体征心律166次/min,呼吸32次/min,血压80/47 mmHg(1 mmHg=0.133 kPa),氧饱和度80％,体温39.5℃,查体:浅昏迷,双瞳孔等大正圆,直径约2 mm,对光反射存在,无颈项强直,口周及口腔内可见较多清亮唾液,双肺呼吸音粗,双肺可闻及少量湿性啰音,左下肺为著,心律齐,各瓣膜听诊区未及杂音.腹部查体未见异常.双侧腱反射存在,双侧病理征阴性.血气:pH 6.95, PCO288 mmHg, PO248 mmHg, Lac 8.0 mmol/L,故立即予气管插管、呼吸机辅助通气,建立静脉通路补液及去甲肾上腺素泵入升压治疗,并立即收入本院急诊ICU.患者入院后主要血化验结果见表2.

目的 观察糖尿病性黄斑水肿(DME)患者经玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗后眼球后动脉血流的变化.方法 前瞻性选取2016年11月至2017年8月期间在首都医科大学附属北京友谊医院收治伴有DME的糖尿病视网膜病变患者20例(20眼).彩色多普勒超声检查检测患者治疗前及治疗后ld、1周的眼球后血管视网膜中央动脉(CRA)、眼动脉(OA)血流动力学参数,包括收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及搏动指数(PI).比较分析治疗前后的眼血流变化.结果 20例(20眼)DME患者平均年龄为(61.65±10.02)岁,其中男性11例(11眼),女性9例(9眼)术后第1天注射眼CRA的眼血流指标PSV、EDV、P1、R1结果分别为7.22±1.84 cm/s、1.88±0.49 cm/s、1.41±0.17、0.73±0.05,与术前进行比较,呈现明显下降(P＜0.01),RI、PI差异无统计学意义(P＞0.05).术后1周注射眼的该4项眼血流指标差异均无统计学意义(P＞0.05).OA的4项眼血流指标治疗前后比较,差异无统计学意义(P＞0.05).患者对侧眼在治疗前后比较,CRA、OA的眼血流指标差异均无统计学意义(P＞0.05).结论 玻璃体腔抗VEGF注药可短暂影响DME患者注射眼的眼部血流,不影响对侧眼的眼血流动力学.

目的 对心脏外科术前患者家属心理反应予以分析,探讨相应护理对策.方法 选取2018年1月～2019年1月本院行心脏外科手术病患家属150例为研究对象,借助问卷调查形式,对病患家庭状态,家属心理状态予以调查,统计心理反应状态;开展护理工作前,将家属分至对照组(常规护理)、观察组(心理护理),各75例,比较两组家属SAS、SDS评分.结果 150例病患家属中146例家属均产生焦虑恐惧心理,占比97.33％,居于首位;经心理护理干预后,观察组SAS、SDS评分均低于对照组(P＜0.05).结论 借助对病患家属于心脏外科术前心理反应行分析并施以相应护理措施方式,病患诊治依从度提升,医患关系改善,提升诊治成效.

患者男性,68岁.因左眼突发视物模糊2个月、加重1 d,于2015年9月28日至首都医科大学附属北京友谊医院眼科就诊.既往史:高血压30年,高压最高200 mmHg (1 mmHg=0.133 kPa),低压最高100 mmHg,口服吲达帕胺片、硝苯地平控释片治疗,血压控制稳定.2型糖尿病20年,口服二甲双胍、格列美脲治疗,现血糖控制好.脑梗死1年(2014年7月25日),口服阿司匹林、阿托伐他汀治疗.1年前(2014年9月),患者因左颈内动脉重度狭窄(狭窄90%),行左颈内动脉支架置入术.7年前(2008年)患者因左眼老年性白内障,行左眼白内障超声乳化抽吸+人工晶状体置入手术.4年前(2011年)患者因右眼老年性白内障,行右眼白内障超声乳化抽吸+人工晶状体置入手术.3d前,患者因左眼后发性白内障,行左眼掺钕钇铝石榴石晶状体激光后囊切开术.吸烟、饮酒30年,已戒烟、戒酒1年.2个月前(2015年8月1日),患者突发左眼视物模糊,视力(国际标准视力表)右眼1.0,左眼0.25,眼压(非接触眼压计)右眼9 mmHg,左眼11 mmHg,双眼前节未见异常,眼底见双眼动脉变细,左眼著,视网膜散在出血点及硬性渗出(图1);FFA示双眼少许视网膜微动脉瘤和小片出血遮挡,左眼臂-视网膜循环时间延长,晚期视网膜血管壁荧光着染(图2,3);结合眼底检查诊断双眼糖尿病视网膜病变Ⅱ期.予改善循环、保护神经等药物治疗.1d前,患者自觉症状加重,复查:视力右眼1.0,左眼0.08,眼压右眼14 mmHg,左眼24 mmHg,左眼虹膜大量丛状新生血管(+++)(图4),眼前节未见其他异常,眼底所见较2个月前无变化,复查FFA未见视网膜非灌注区及新生血管生长.

Objective: To establish a method coupled with everted gut sacs and isolated vascular, and study the effects of Yindan Xinnaotong Capsule on intestinal absorption of vasoactivity. Methods: The everted intestinal sac method was performed to prepare the intestinal absorption solution. The isolated rat aortic ring model was used to observe the effects of intestinal absorption on the vasoactivity in vitro. Additionally, the main compounds (ginsenoside Rg1, ginsenoside Rb1, ginsenoside Re, ginsenoside Rd, notoginsenoside R1, ginkgolide A, ginkgolide B, ginkgolide C, bilobalide, rutin, and tanshinone IIA) in intestinal absorption solution were determined by UPLC-QQQ. Results: The intestinal absorption liquid of Yindan Xinnaotong Capsule in the concentration range of 100-1 600L had a concentration-dependent vasodilation. Eleven constituents could be absorbed by gut sacs. The cumulative amount of intestinal absorption of all components was the highest in high concentration and the lowest in low concentration. Conclusion: The method is simple and controllable. It can reflect the true biological activity of samples, which provide a reference for the quality evaluation of Yindan Xinnaotong Capsule.

· AIM:To compared the therapeutic effect of improved macular hole surgery to traditional macular hole surgery for idiopathic macular hole (IMH).· METHODS:From April 2014 to June 2017,28 eyes of 28 IMH patients who were treated in our hospital were selected consecutively and received surgical treatment independently performed by the same physician in our hospital.The patients were divided into A (traditional group) and B (improvement group) groups.All 13 cases in Group A were treated with traditional vitrectomy internal limiting membrane peeling and C3 F8 tamponade,while all 15 cases in Group B were treated with improved indocyanine green-assisted internal limiting membrane peeling combined with macular hole reconstruction and air tamponade.All patients were reviewed at 1wk,1,3,and 6mo after surgery.The best corrected visual acuity (BCVA) before and after the operation,operation time,closure rate of the macular hole during the last review and prone time were compared between the two groups of patients.· RESULTS:There was no significant difference in closure rate between the two groups (P＞ 0.05).Postoperative BCVA increased in both groups compared with preoperatively and the differences were statistically significant (P ＜ 0.05).But there was no significant difference on BCVA between the two groups both preoperatively and postoperatively (P ＞ 0.05).The operation time in Group B was significantly shorter than that in Group A (P＜0.05).Prone time in Group B was significantly shorter than that in Group A,the difference was statistically significant (P＜0.05).· CONCLUSION:This study shows that compared with the traditional group,the improved indocyanine green-assisted peeling of internal limiting membrane combined with macular hole reconstruction and air tamponade can achieve similarly high closure rates while the operation procedure was simplified and the operation time was shortened.Reduced number of instruments into and out of the incision can reduce the incidence of complications.The postoperative patient's prone time is significantly shortened,with high comfort and good compliance.

目的 进一步深入细致的探讨和分析综合护理干预联合常规护理在心脏搭桥术后患者中的应用价值和效果.方法 抽选2016年1月到2017年1月这个时间范围内,在我院接受心脏搭桥术治疗的患者80例,把他们作为本次研究的研究对象,按照随机的方法,把他们分为两个组别,分别是对照组和观察组,两个组有患者分别是40例.针对对照组患者所采用的是常规性的护理方法,而观察组的患者所采用的是在常规护理办法的基础上再联合应用综合护理干预.然后有针对性的运用汉密尔顿焦虑量表(HAMA)等对两个组别的患者在展开相应的护理前后的心理状况,进行科学合理的评估,采用SF-36生活质量量表对于两个组的患者,在护理前后所体现出的生活质量展开有针对性的评定,同时有针对性的比较和分析两组患者出现并发症的情况.结果 在进行相应的护理模式之前,两个组别的患者HAMA、HAMD评分比较,差异没有十分明显的统计学意义(P>0.05),护理后两个组别的患者的HAMA、HAMD评分要比进行护理方式之前有十分明显的降低,观察组患者所体现出的评分降低更加明显,差异有十分明显的统计学意义(P<0.05);护理前两个组别的患者的SF-36生活质量评分进行相应的比较,差异没有十分明显的统计学意义(P>0.05),护理后两个组别的患者的SF-36生活质量评分都要比护理之前高很多,观察组患者的增加程度更加明显,差异比较明显,有相应的统计学意义(均P<0.05);观察组手术后出现并发症的几率(10.00%)明显要比对照组(17.50%)低很多,差异有比较明显的统计学意义(P<0.05).结论 科学合理的运用常规护理联合综合护理干预用于心脏搭桥术患者,起到了十分良好的作用,能十分明显的改善患者预后,值得在临床上大力推广和深入应用.

Objective: To evaluate the impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome (ACS). Methods: This multi-center cross-sectional study collected data from 34 hospitals covering 22 provinces in China. Hospitals were randomly divided into four groups: control group(routine treatment and care), promotional calendar group (routine treatment and care plus giving propaganda desk calendar to patients), education group (routine treatment and care add patients education by nurses) and combined intervention group (promotional calendar and education).At least 90 patients with ACS were consecutively enrolled from each involved hospital from April 15, 2012 to June 30, 2013. To reduce the impact of uneven distribution of inter-group variables on the results, 1∶1∶1∶1 propensity score matching method was used. The drug usage for secondary prevention and prognosis wasobtainedat 6 months after hospital discharge. Results: (1) A total of 3 391 patients were selected and 2 244 patients were included for the final analysisafter propensity score analysis. (2) At 6 months after discharge, the adherence rates of antiplatelet, statins, angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB), β-blocker and the combination of 4 medications were similar between control group and promotional calendar group (all P>0.016).The adherence rates of antiplatelet and statins were 97.0% (526/542) and 91.0% (493/542) in the education group, 3.7% and 5.5% higher than in the control group (both P<0.016). The adherence rates of statins,ACEI/ARB and combined medication were 91.0% (496/545), 68.3% (372/545) and 53.2% (290/545) in the combined intervention group,significantly higher than in the control group (5.5%,8.3% and 9.6%, all P<0.016). (3) Poisson regression analysis showed that the adherence of antiplatelet drugs in the education group was 3.4%(OR=1.034, 95%CI 1.007-1.060,P<0.05) and 3.5%(OR=1.035, 95%CI 1.007-1.063, P<0.05) higher than in the control group and the promotional calendar group, and the statins adherence rate was 5.5%(OR=1.055, 95%CI 1.012-1.101,P<0.05) higher than in the control group. The antiplatelet drug adherence rates in the combined intervention group were 3.0% (OR=1.030, 95%CI 1.002-1.058,P<0.05) and 3.1% (OR=1.031, 95%CI 1.003-1.060,P<0.05) higher than in the control group and the promotional calendar group, respectively, and statin adherence was 6.1% (OR=1.061, 95%CI 1.017-1.107,P<0.01) higher than in the control group. The adherence rates of ACEI/ARB in combined intervention group were respectively 15.4%(OR=1.154, 95%CI 1.057-1.259, P<0.01),20.0%(OR=1.200, 95%CI 1.096-1.314, P<0.01) and 25.5%(OR=1.255, 95%CI 1.142-1.380, P<0.01) higher than in the control group, promotional calendar group and education group. The adherence rates of combined medication in combined intervention group were respectively 21.6%(OR=1.216, 95%CI 1.079-1.371, P<0.01),21.5%(OR=1.215, 95%CI 1.077-1.371, P<0.01) and 27.8%(OR=1.278, 95%CI 1.126-1.450, P<0.01) higher than in the control group, promotional calendar group and education group. (4) At 6 months after discharge, the control rates of blood pressure (<140/90 mmHg,1 mmHg=0.133 kPa) in the education group were significantly higher than in the control group and promotional calendar group (78.7% (398/506) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016),and the control rates of blood pressure in combined intervention group were higher than in the control group and promotional calendar group (78.2% (376/481) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016).The rehospitalization rates were 7.0% (39/561) in the promotional calendar group, and 7.6% (42/561) in the education group, both significantly higher than in the control group (3.8% (21/561), all P<0.016).The rate of the low density lipoprotein cholesterol<2.07 mmol/L and the rate for all-cause mortality were similar among groups (all P>0.016) . Conclusion: Post-discharge medication adherence in ACS patients can be enhanced by either promotional calendaror nurses education strategy, and the efficacy is better by nurse education as compared with promotional calendar, the combination of both methods can further increase the post-discharge medication adherence rates in ACS patients.