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目的探讨对老年心血管疾病患者进行白内障手术前综合因素评估的临床价值。方法回顾性分析近5年我科对218例(255只眼)老年心血管疾病患者施行白内障手术的相关临床资料。结果13例(14只眼)老年心血管疾病患者因术前评估发现手术禁忌证、无法耐受手术或手术后视力无法提高而放弃手术;205例(241只眼)老年心血管疾病患者安全施行白内障超声乳化或小切口白内障摘除联合人工晶状体植入术,其中56例有明显心脏疾病症状者经内科调整用药,在心电监护和持续低流量吸氧下施行手术。术后随访1~18个月(平均6.3个月),术后最佳矫正视力:光感至<0.05者8例(9只眼),占3.9%;0.05至<0.3者32例(39只眼),占15.6%;≥0.3者165例(193只眼),占80.5%。手术脱残率为78.1%,脱盲率为91.8%。手术中均无严重全身和局部并发症发生,达到预期效果,1例手术后因吸入性肺炎转入呼吸内科抢救治疗。结论老年心血管疾病患者施行白内障摘除联合人工晶状体植入术应加强术前综合因素评估,综合性医院应发挥其优势。对老年心血管疾病患者的围手术期处理,应严格掌握手术适应证和手术禁忌证;镇静类、肾上腺素类及糖皮质激素类药物的应用应个体化;特殊类型患者手术中采用心电监护和持续底流量吸氧,使手术风险降至最低;对于Ⅳ级及以上的晶状体核采用非超声乳化小切口白内障摘除联合人工晶状体植入术较白内障超声乳化联合人工晶状体植入术为佳。
Objective To investigate the clinical value of comprehensive evaluation of preoperative cataract surgery in elderly patients with cardiovascular diseases. Methods The clinical data of 218 cases (255 eyes) of elderly patients with cardiovascular diseases undergoing cataract surgery in our hospital in recent 5 years were analyzed retrospectively. Results Thirteen patients (14 eyes) with cardiovascular disease underwent surgery due to preoperative evaluation of contraindications for surgery, failure to tolerate surgery or surgery, and surrender of their eyesight; 205 patients (241 eyes) with elderly cardiovascular disease were safely administered Cataract phacoemulsification or small incision cataract extraction combined with intraocular lens implantation, of which 56 patients with obvious symptoms of heart disease by medical adjustment medication, ECG and continuous low-flow oxygen under the operation. The patients were followed up for 1 to 18 months (mean, 6.3 months). The best corrected visual acuity after surgery was: 8 cases (9 eyes) with light perception to <0.05, accounting for 3.9%; 32 cases (39 cases Eyes), accounting for 15.6%; 165 patients (≥ 193), accounting for 80.5%. The rate of surgical disability was 78.1% and the rate of blindness was 91.8%. No severe systemic and local complications occurred during the operation, which achieved the expected results. One case of pneumonia after surgery was transferred to Respiratory Medicine for rescue and treatment. Conclusion The elderly patients with cardiovascular diseases should be cataract extraction combined with intraocular lens implantation should strengthen the preoperative assessment of comprehensive factors, general hospitals should play its advantages. Perioperative management of elderly patients with cardiovascular disease should be strictly controlled surgical indications and surgical contraindications; sedation, epinephrine and glucocorticoid drugs should be individualized; special type of patients with ECG monitoring And continuous inflow of oxygen, the surgical risk to a minimum; for Ⅳ and above the lens nucleus with non-phacoemulsification small incision cataract extraction combined with intraocular lens implantation than cataract phacoemulsification combined with intraocular lens implantation is better.