钟小艺

[摘要] 目的 分析探讨羊膜移植术联合高浓度自体血清治疗早期严重眼化学伤的的临床疗效。方法 选取2013年6月～2016年2月期间我院收治的98例早期严重眼化学伤患者，共109只患眼。采用随机数字表法分为观察组45例（53眼）和对照组45例（56眼）。对照组患者采用高浓度自体血清治疗，观察组患者采用羊膜移植术联合高浓度自体血清治疗。分析比较两组患者的植片存活情况、临床疗效、术后并发症及术后1年的视力情况。结果 观察组患者植片存活率大于对照组，差异有统计学意义（P<0.05）；观察组患者植片存活保持透明的患眼占比大于对照组，差异有统计学意义（P<0.05）；两组患者植片存活保持半透明和植片存活但混浊的患眼占比比较无统计学意义（P>0.05）；观察组患者的治疗有效率大于对照组，差异有统计学意义（P<0.05）；Mann-Whitney检验结果显示，试验组治疗后临床效果优于对照组（P<0.05）；观察组患者术后并发症比例小于对照组，差异有统计学意义（P<0.05）；术后1年，两组患者视力≥0.30、0.10～0.23、0.01～0.10的患者比例比较无统计学意义（P>0.05）；观察组患者视力在指数以下的患者比例小于对照组，差异有统计学意义（P<0.05）。结论 羊膜移植术联合高浓度自体血清治疗早期严重眼化学伤，能显著提高患者的植片存活率，改善患者术后视力恢复。联合治疗安全有效，值得临床推广应用。

[關键词] 改良羊膜移植术；自体血清；早期；严重；眼化学伤

[中图分类号] R779.1 [文献标识码] A [文章编号] 2095-0616（2017）12-218-04

Clinical observation of amniotic membrane transplantation combined with autologous serum in the treatment of early severe ocular chemical injury

ZHONG Xiaoyi

Ent of Enping City People's Hospital， Enping 529400， China

[Abstract]Objective To investigate the clinical efficacy of amniotic membrane transplantation combined with autologous serum in the treatment of early severe ocular chemical injury. Methods A total of 98 patients， 109 eyes with severe ocular chemical injury were enrolled in our hospital from June 2013 to February 2016.The patients were randomly divided into observation group and control group. Patients in the control group were treated with high concentration of autologous serum， while the patients in the observation group were treated with amniotic membrane transplantation combined with high concentration of autologous serum. The survival rate， clinical efficacy， postoperative complications and postoperative visual acuity of 1 yearsof the two groups were analyzed and compared. Results Patients with graft survival rate than the control group， the difference was statistically significant（P<0.05）； the observation group of patients with graft survival transparent eyes accounted for more than the control group， the difference was statistically significant（P<0.05）； two patients with graft survival and graft survival but maintain translucent turbid eyes for compared with no statistical significance（P>0.05）； the treatment group effective rate than the control group， the difference was statistically significant（P<0.05）. Mann-Whitney test results show that the experimental group after the treatment in the control group than the clinical effect（P<0.05）；the postoperative complications in the observation group were less than those in the control group， and the difference was statistically significant（P<0.05）；1 years after surgery， two groups of patients with visual acuity 0.30， 0.10～0.23 0.01～0.10， the proportion of patients with no statistical significance（P>0.05）； patients in the observation group in the index below the proportion of patients with visual acuity less than the control group， the difference was statistically significant（P<0.05）. Conclusion Amniotic membrane transplantation combined with autologous serum in the treatment of early severe ocular chemical injury can significantly improve the survival rate of the patients， and improve the postoperative visual acuity. Combination therapy is safe and effective， worthy of clinical application.

[Key words] Modified amniotic membrane transplantation； Autologous serum； Early； Severe； Ocular chemical injury

眼化学伤指眼部接触到强酸、强碱等物质，引起眼球外层腐蚀穿孔[1]。高浓度自体血清是目前临床治疗眼化学伤的一线方法，但临床数据显示高浓度自体血清治疗易引起角膜斑翳、睑球粘连、眼睑畸形、溢泪等多种并发症，影响患者视力健康，疗效欠佳[2-4]。在此基础上，有研究提出羊膜移植术，将其应用于疗难治性角膜上皮疾病[5]。结果显示，其治疗效果较好。本研究认为这是一个很有价值的研究，因此，考虑将羊膜移植术与高浓度自体血清联合，应用于早期严重眼化学伤，提高其治疗效果。现报道如下。

1 资料与方法

1.1 一般资料

选取2013年6月～2016年2月期间我院收治的98例早期严重眼化学伤患者，经我院伦理委员会批准审批通过，确认患者对实验知情同意。……