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新生儿视网膜出血与脐动脉血气分析的相关性研究

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新生儿视网膜出血与脐动脉血气分析的相关性研究

作者：高文蔷承德医学院

学位级别：硕士

目的:近些年来,随着眼底检查手段的不断提高,新生儿视网膜出血(RH)的诊断率也有了明显的增长。有研究指出,新生儿窒息与新生儿视网膜出血的发生有明显的关系。临床上,新生儿脐动脉血气分析被作为诊断新生儿窒息的重要指标。本研究以新... 详细信息

目的:近些年来,随着眼底检查手段的不断提高,新生儿视网膜出血(RH)的诊断率也有了明显的增长。有研究指出,新生儿窒息与新生儿视网膜出血的发生有明显的关系。临床上,新生儿脐动脉血气分析被作为诊断新生儿窒息的重要指标。本研究以新生儿脐动脉血气分析中的p H、氧分压、二氧化碳分压、碱剩余(BE)、碳酸氢根离子为研究指标,回顾性分析其与新生儿视网膜出血之间的关系。方法:回顾性研究,选取2019年10月-2020年10月在本院出生且在出生后三天内进行了Ret CamⅢ视网膜检查的308名新生儿,并根据纳排标准选出265名新生儿,根据新生儿有无视网膜出血分两组。视网膜有出血组62例,视网膜无出血组203例,并收集脐动脉血气分析结果。应用独立样本t检验比较两组间p H、氧分压、二氧化碳分压、碱剩余(BE)、碳酸氢根离子的差异;应用卡方检验分析脐动脉血气分析中的p H与新生儿视网膜出血发生的关系。根据不同程度视网膜出血进行分组,各组间的p H值与视网膜出血程度进行ANOVA分析有无相关性,3组间p H值差异采用LSD进行比较;P视网膜出血与新生儿脐动脉血气分析中的p H视网膜无出血的新生儿约占比77%(203/265);1度出血的约占比12%(33/265);2度出血的约占比7%(19/265);3度出血的约占比4%(10/265)。3.新生儿视网膜有出血组的脐动脉血气分析中的p H低于新生儿视网膜无出血组的水平、氧分压低于新生儿视网膜无出血组的水平、二氧化碳分压高于新生儿视网膜无出血组的水平、碱剩余(BE)高于新生儿视网膜无出血组的水平、碳酸氢根离子低于新生儿视网膜无出血组的水平,P视网膜出血的程度与p H具有相关性,P视网膜出血的新生儿,其脐动脉血气分析中的p H各组间存在明显差异,P视网膜出血程度越重,p H分布范围数值越小。结论:1.新生儿脐动脉血气分析中的p H视网膜出血的高危指标。2..新生儿脐动脉血气分析中的p H越低,新生儿发生视网膜出血的可能性越大,同时,视网膜出血的程度也相对更严重。

关键词：新生儿视网膜出血脐动脉血气分析窒息视网膜检查

镰状红细胞病中结膜和视网膜血管改变的危险因子

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世界核心医学期刊文摘（眼科学分册） 2006年第8期2卷 16-17页

作者： Lima C.S.P. Rocha E.M. Silva N.M. 王永强 Department of Internal Medicine Faculty of Medical Sciences State University of Campinas Campinas S?ao Paulo 13083- 970 Brazil .

Purpose: The aim of this study was to clarify whether the clinical, laboratory and genetic aspects of sickle cell disease (SCD) influence the occurrence of vessel alterations in the conjunctiva and retina. Methods: A total of 102 SCD patients underwent biomicroscopical and retinal examination, in addition to evaluations of haemoglobin (Hb) and haematocrit (Ht) levels, fetal haemoglobin (HbF) estimations, serum creatinine and albuminuria levels, glomerular filtration rate (GFR) values, phenotypes, β -globin gene haplotypes and α -thalassaemia. The relationship between ocular vessel alterations and clinical, laboratory and genetic features were evaluated using chisquared or Fisher tests and logistic regression analysis. In 13 patients on enalapril treatment, a second ophthalmological evaluation was performed after a 12- month period to evaluate the longitudinal effect of the drug on ocular vessels. Results: Conjunctival vessel alteration (CVA) was not influenced by age, gender, HbF estimation, serum creatinine and albuminuria levels, GFR values, β -globin gene haplotypes or α -thalassaemia. However, increased frequencies of CVA were found in patients with Hb ≤ 9.0 g/dl, Ht ≤ 26.7% and sickle cell anaemia (SS) phenotype. Retinal vessel alteration (RVA) was identi-fied only in patients aged 17 years or older. Enalapril did not demonstrate ocular vessel amelioration after 12- months of daily use. Conclusion: The results indicate that lower Hb and Ht levels and SS phenotype are risk factors for CVA, and age over 17 years may be risk factors for RVA in SCD patients.

关键词：镰状红细胞病视网膜血管视网膜检查胎儿血红蛋白 α-地中海贫血 β-球蛋白显微镜检查普利单

视网膜血管的远程医疗筛查技术(“能说话的眼”)

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世界核心医学期刊文摘（眼科学分册） 2005年第9期1卷 37-38页

作者： Michelson G. Groh M. Groh M.J.M. 张少娟 Augenklinik mit Poliklinik Universit¨at Erlangen-N¨urnberg Schwabachanlage 6 91054 Erlangen Germany Dr.

Background: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with regard to strokes and heart attacks. Aim of the Study: The aim of this study was to perform a prospective screening examinationwith regard to retinalmicrovascular abnormalities as well as an extended vessel diagnosis in a subgroup of patients with lower arteriovenous risk values. Methods: In the course of a prospective cross-sectional study (“Talking Eyes”) between 1.9.2001 and 1.8.2002 a telemedical-supported screening of the retina (study 1) was carried out in 7,163 subjects. The patients were selected without any inclusion or exclusion criteria. The mean age was 48.2±8 years (18-83 years) with a sex distribution of 39.2%females to 60.8%males. Digital fundus photos of the right and left eyes were taken for all patients. The pictures were taken without pupil dilation using a CANON-NM camera. The pictures and case histories were stored in a central server using web-based software (MedStage, Siemens). In a central reading centre, the arteriovenous ratio of both eyes was determined telemedically using the Parr-Hubbard formula and the retinas subjected to a standardised examination by an ophthalmologist. The retinal risk factor was calculated on the basis of the arteriovenous ration, the presence of microvascular abnormalities and the case history. The reproducibility of measurement of the arteriovenous ratio (Kronbach alpha coefficient) was evaluated by double measurements on 1,332 images. In a subgroup of study 1 with arteriovenous ratio values < 0.76 (N=107), an extended vessel diagnosis with measurement of 24-h blood pressure and vessel-relevant blood values (homocysteine, cholesterol, LDL, HDL, CRP, TG, HbA1c) was carried out (study II). Results: Study 1: The Kronbach alpha coefficient as a measure of reproducibility amounted to 0.77. The mean arterioveno

关键词：视网膜血管筛查技术远程医疗动静脉比视网膜微血管视网膜出血舒张期血压动静脉交叉征视网膜检查血压测定

摩洛哥先天性风疹综合征的费用:一项快速回顾性评估

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世界核心医学期刊文摘（妇产科学分册） 2005年第6期1卷 6-7页

作者： Bloom S. Rguig A. Berraho A. 王雅楠 National Immunization Program Centers for Dis. Contr. and Prev. Atlanta GA United States

Background WHO recommends that countries considering introduction of rubella vaccine into their immunisation programme assess their burden of congenital rubella syndrome, to determine whether vaccination is warranted. However, few guidelines exist for such assessments in developing countries. We retrospectively estimated the burden of congenital rubella syndrome in Morocco, and assessed our methods of rapid case finding. Methods We undertook case finding in the two cities with Morocco’ s main tertiary care referral centres, using medical records from births between Jan 1, 1990, and May 31, 2002, disability records from 1965 to 1997, and retinal examinations from deaf students born between 1985 and 1994, applying the WHO definition for a clinically confirmed case of congenital rubella syndrome. We also reviewed disability data for evidence of epidemic periodicity and estimated yearly incidence of the syndrome from congenital cataract data for births between 1990 and 2001. Findings We identified 62 clinically confirmed cases of congenital rubella syndrome from medical records, 148 from disability records, and 15 in deaf students. We noted no epidemic periodicity in disability data, and estimated a yearly incidence of the syndrome in Morocco of 8.1- 12.7 cases per 100 000 livebirths. Interpretation We show evidence of congenital rubella syndrome in Morocco and support the addition of rubella vaccination to the national programme. Various data sources can be explored to rapidly assess burden of the syndrome; ophthalmology departments and outpatient cardiology clinics could offer the most potential for such case finding, dependent on documentation practices.

关键词：风疹疫苗病例记录免疫计划视网膜检查先天性白内障三级医疗文件记录流行周期活产指导方针

二极管激光光凝术治疗早产儿阈值视网膜病变后眼压的改变

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世界核心医学期刊文摘（眼科学分册） 2005年第2期1卷 55-55页

作者： Axer-Siegel R. Bourla D. Friling R. R. Axer-Siegel 黎黎 Department o f Ophthalmology Rabin Medical Center Petah Tikva Israel Dr.

Purpose To investigate the intraocular pressure (IOP) variations occurring aft er indirect diode laser photocoagulation for threshold retinopathy of prematurit y. Design Prospective, nonrandomized, comparative study. Participants A study gr oup 21 consecutive premature babies (42 eyes) undergoing diode laser photocoagul ation for retinopathy of prematurity and control groups 32 premature babies (64 eyes) undergoing retinal examination with or without scleral indentation. Interv ention Intraocular pressure was measured with a portable electronic tonometer be fore, immediately after, and 1, 2, and 3 days after diode laser photocoagulation in the study group; before retinal examination in control group 1; and before a nd after retinal examination with scleral indentation in control group 2. Main o utcome measure Intraocular pressure after diode laser photocoagulation for thres hold retinopathy of prematurity. Results Mean IOP in the study group rose from 1 5 mmHg (standard deviation SD=4.1) before coagulation to 33.2 mmHg (SD = 7.8; range, 20-50) immediately after, and then dropped to 22.2 (SD=5.2), 16.5 (SD=3) , and 14.5 mmHg (SD=2.1) 1, 2, and 3 days later, respectively. All the changes w ere statistically significant at P < 0.0001, except for the difference between d ays 2 and 3(P=0.096). Mean baseline IOPs were 16.3 mmHg (SD=3.7) in control grou p 1 and 15.7 mmHg (SD=2.3) in control group 2 (P=0.84 between control group 1 an d study group, and P=0.32 between control group 2 and the study group). At termi nation of the retinal examination with scleral indentation (control group 2), IO P measured 15.1 mmHg (SD=2.2) (P=0.49 compared with baseline). Conclusions Intra ocular pressure may be significantly elevated after diode laser photocoagulation for retinopathy of prematurity. The mechanism and long-term clinical implicati ons of this observation should be investigated.

关键词：光凝术治疗二极管激光视网膜病变视网膜检查激光光凝术电子眼压计统计学显著性非随机对照于术

特发性黄斑旁中心凹毛细血管扩张伴黄斑裂孔形成

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世界核心医学期刊文摘（眼科学分册） 2006年第10期2卷 34-34页

作者： Olson J.L. MandavaN. 刘瑛 Department ofOphthalmology Rocky Mountain Lions Eye InstituteUniversity of Colorado School of Medicine1675 UrsulaAuroraCO 80045United States

Background:To report the occurrence of a full thickness macular hole in association with idiopathic parafoveal ***:Observational case ***:A 60-year-old female with a history of bilateral idiopathic parafoveal telangiectasia presented with acute complaints of decreased vision and metamorphopsia in her right *** patient’s retinal examination was significant for idiopathic parafoveal telangiectasia bilaterally,and a new,full-thickness macular hole in the right eye which was confirmed by optical coherence ***:Full-thickness macular hole formation may occur in conjunction with idiopathic parafoveal telangiectasia,which has not been reported to *** parafoveal telangiectasia,IPT,is a clinical entity with distinct biomicroscopic and fluorescein angiographic findings which may be divided into developmental and acquired *** macular hole formation is a relatively common condition,which tends to occur more frequently in females in their 7th and 8th decades of *** parafoveal telangiectasia has been reported in association with lamellar macular holes,but,to our knowledge,not with a full thickness macular *** in we report the case of a patient with bilateral idiopathic parafoveal telangiectasia who developed a full-thickness macular hole.

关键词：黄斑裂孔中心凹毛细血管扩张生物显微镜视网膜检查右眼视力视物变形发育性观察性层裂

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OCT是升级版CT检查技术吗

家庭医学（上半月） 2016年第2期31卷 62-62页

作者：姜允申南京医科大学

北京读者袁某来信说：我42岁,女,近期因左眼视物模糊,有遮挡感就医,医生开出了B超、眼底造影和OCT检查。OCT是什么检查？是传统的CT技术的升级吗？答袁某读者：OCT全称Optical Coherence Tomography,即光学相干断层成像术,是一种高分辨... 详细信息

北京读者袁某来信说：我42岁,女,近期因左眼视物模糊,有遮挡感就医,医生开出了B超、眼底造影和OCT检查。OCT是什么检查？是传统的CT技术的升级吗？答袁某读者：OCT全称Optical Coherence Tomography,即光学相干断层成像术,是一种高分辨率、非接触性的生物组织成像术。目前已经广泛用于眼科的视网膜检查,医学界正探索在食道、胃、子宫、

关键词：视网膜检查成像术北京读者眼底造影左眼视物模糊 CT检查技术高分辨率 OCT 非接触性显微结构

单眼玻璃体后脱离发生后对侧眼发生玻璃体后脱离的进程

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世界核心医学期刊文摘（眼科学分册） 2005年第2期1卷 52-52页

作者： Hikichi T. Yoshida A. 张磊 Department of Ophthalmology Asahikawa Medical College Asahika- wa Japan Dr.

Purpose To determine when posterior vitreous detachment (PVD) develops in the fellow eye after development in the first eye. Design Prospective, observational case series. Participants Fifty-one patients with acute unilateral PVD partici pated in the study. Methods All patients underwent a comprehensive ocular examin ation, including a dynamic vitreous examination using biomicroscopy with and wit hout a preset lens and retinal examination with scleral depression, every 3 mont hs at least until PVD developed in the fellow eye. Results Posterior vitreous de tachment developed in 4 eyes (8%) within 6 months, 12 eyes (24%) within 1 year , 24 eyes (47%) within 18 months, 33 eyes (65%) within 2 years, 41 eyes (80%) within 30 months, and 46 eyes (90%) within 3 years. In 5 eyes (10%), PVD did not develop during the follow-up period of more than 3 years. Conclusions Poste rior vitreous detachment develops frequently in the felloweye from 6 months to 2 years after development in the first. These findings are useful for the managem ent of patients with unilateral PVD.

关键词：玻璃体后脱离对侧眼巩膜压迫器眼科检查视网膜检查生物显微镜前置镜前瞻性观察序列研究

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计算机描记的激光眼扫描

国外医学情报 1984年第16期 275-275页

作者：张玉勤

美国芝加哥消息:制造者声称,一种应用计算机技术产生眼内部结构的数字增强图象的新诊断用激光,将取代眼底照像和检眼镜检查。现已对人进行试验,预期此种激光,通过测定视杯与视乳头比例的量的改变,使医生能够早期诊断青光眼。也能测定... 详细信息

美国芝加哥消息:制造者声称,一种应用计算机技术产生眼内部结构的数字增强图象的新诊断用激光,将取代眼底照像和检眼镜检查。现已对人进行试验,预期此种激光,通过测定视杯与视乳头比例的量的改变,使医生能够早期诊断青光眼。也能测定视斑的改变。在视网膜荧光血管造影术中,此种激光可使染料剂量从500mg减少至50mg,因此此技术对重复检查和有过敏倾向的病人比较安全。在当地举行的美国眼科学院年会上介绍了这种名为诊断扫描激光7000(DSL7000)的装置,是由圣地亚哥视力诊断仪器厂制造的。

关键词：检眼镜检查过敏倾向视网膜荧光视杯重复检查眼内部数字增强诊断仪器视网膜检查血管造影术