目的:通过分析1061例1061眼基层防盲复明白内障手术的围手术期情况,探讨手术前后的安全流程。方法:回顾性分析2009年度我院1061例白内障防盲复明患者的围手术期资料,总结和规范基层防盲复明白内障手术安全、顺利、高效完成的关键流程。结果:来院患者69批中筛查符合手术适应证的患者共1 061例。术前矫正视力低于手动/眼前者17.0%,<0.1者22.1%,0.1～0.3者59.0%,0.3以上者1.9%。过熟期或硬核267例(25.2%),白内障伴晶状体不全脱位2例(0.2%),既往青光眼滤过手术史13例(1.2%),既往玻璃体切割手术史3例(0.3%),陈旧性葡萄膜炎9例(0.8%),角膜内皮计数<2000个/cm2 44例(4.1%)。其中超声乳化手术完成1048例(98.8%),13例改行ECCE。主要手术并发症分别为:后囊破裂27例(2.5%),术后3d角膜水肿54例(5.1%),眼内炎0例,人工晶状体未植入1例(0.1%)。术后3mo复查,脱盲率达97.8%(裸眼视力>0.1),脱残率84.2%(矫正视力>0.3)。矫正视力>0.6者36.7%。手术患者中,眼后段疾病以高度近视眼底病变和年龄相关性黄斑变性最多,分别为3.7%和3.3%,其次为眼底出血、视神经萎缩等病变。各类心血管疾病的检出率必须同时给予心电监护者达7.3%。术前抗菌素使用、视功能预测、风险度评估、低价位染色剂和张力环的备用、超声乳化转囊外参考指标及破囊应急包为关键性的安全措施。结论:防盲复明患者眼部和全身条件复杂,合并眼底疾病比例高,手术难度相对较大。围手术期更应规范各项流程和施行合适有效的安全措施,有助于提高快速大量白内障手术的安全性和有效性。更好地实现以较小的医疗价格负担得到安全高效的手术治疗,最大程度提升患者的视觉质量,获得最佳的社会效益。

AIM:According to the analysis of 1061 cases(1061 eyes) of cataract surgery in primary blindness-prevention project,to explore the key processes in perioperative period in order to find a safe and effective procedure.METHODS: According to the information of 1061 cases in the blindness-prevention project in 2009,the perioperative processes were summarized and regulated.RESULTS:Among these 1061 cases who accepted cataract surgery,there were 17.0% cases with the preoperative corrected vision under hand movement,22.1% under 0.1,59.0% between 0.1 to 0.3,and 1.9% better than 0.3.267 cases(25.2%) were hyper matured cataract with/without hard nucleus.There were 2 cases(0.2%) combined with lens dislocation,13 cases(1.2%) accepted anti-glaucoma surgery,3 cases(0.3%) accepted vitrectomy surgery,and 9 cases(0.8%) suffered by obsolescence uveitis,44 cases(4.1%) corneal endothelial cell counting was less than 2000 per square centimetre.Phacoemulsification were performed in 1048 cases(98.8%) and ECCE in 13 cases.The incidence of several primary complications were separately: 27 cases(2.5%) of posterior capsular rapture,54 cases(5.1%) of corneal edema at postoperative 3 days,and 1 case(0.1%) of failure to IOL implantation.None endophthalmitis happened.In 3 months postoperation,the out of blindness rate(uncorrected visual acuity >0.1) was 97.8% and the rate(best corrected visual acuity >0.3) was 84.2%.There were about 36.7% with visual acuity better than 0.6.There were so many cases combined with kinds of fundus diseases,such as retinopathy due to high myopia(3.7%),age-related macular degeneration(3.3%),and so on.CONCLUSION:The conditions of cataract patients who joined in blindness-prevention project were very complex,not only in ocular but also in systemic.The rate combined with fundus diseases was high.In order to make the cataract surgery successful,normative processes in perioperative period are very important.

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中国国家科技支撑计划课题资助项目(No.2006BAI02B04);中国上海市长宁区卫生局科研课题资助项目(No.20094Y25001)