兔眼外傷類(lèi)型與血液動(dòng)力學(xué)變化

172第四軍醫大學(xué)學(xué)報( I Fourth Mil Med Univ)2002;23(18)研究快報·文章編號:1000-2790(2002)18-1726-01鐘血流指數和波幅值明顯下降,平均較傷前下降θ.092‰和0.015Ω.但眼壓回升后于48h全部恢復至傷前水平.眼底兔眼外傷類(lèi)型與血液動(dòng)力學(xué)變化熒光血管造影均見(jiàn)穿孔處魚(yú)嘴樣裂孔,脈絡(luò )膜出血及熒光素滲漏.角膜和睫狀體平部穿孔傷組,傷后30min至4h血流玉,張卯年(解放軍總參門(mén)診部,北京100053指數和波幅值降至最低水平(0.112‰→0.023‰,0.0192→0.004Ω),4h后逐漸恢復,24h恢復至傷前水平.睫狀體平關(guān)鍵詞:眼;血液動(dòng)力學(xué);熒光造影部穿孔傷較角膜穿孔傷恢復延遲.本實(shí)驗25只家兔傷前雙中圖號:R331文獻標識碼:A眼血流圖波幅值和血流指數的變化經(jīng)統計學(xué)處理證實(shí),左右眼各值無(wú)明顯差異,故將傷前后左右眼各值合并,分別取平均Abstract: The Hemodynamic Changes on Experimental值,比較傷前后血流圖各值變化,結果差異非常顯著(zhù)(表1)Hemodynamic changes外傷后兔眼眼壓的變化與血液動(dòng)力學(xué)改變的關(guān)系.外傷前后眼壓測量結果表明:平均眼壓差值越大,血流指數差值也越heoophthalmography and fluorescence fundus angiography.大,說(shuō)明眼壓低于正常范圍即有血液動(dòng)力學(xué)的改變,其改變程The amplitude of wave and blood flow exponent after injuries度與眼壓下降的幅度呈正比(表1were regarded as an index. The results showed that thedegree of affection on ocular blood- retinal barrier and表15種眼外傷傷前、后血流圖波幅值、血流指數、眼壓均值choroidalretinal barrier was depending on the type of injury.的比較The disturbance of ocular circulation lasted longest andstopathological changes were most serious in contusion eyes血流圖波幅值(mm)血流指數(Ω)眼壓均值(kPa)別the five types of injury. The ciliary body perforation with傷前傷后傷前傷后bleeding mostly affected the recovery of rhoophthalmograph高壓氣流沖擊傷0,01590,0078b0.0980,049b2,0among the three types of perforation injuries. It appears that鈍挫傷0,02300,0060b0.133046b2,4the changes of ioP are related to that of hemodynamics after赤道部穿孔傷0.01880.0020b0.1110.012b1.967.33角膜穿孔傷睫狀體穿孔傷0.01910.00601.78raphy is not a good technigue to show the traumabP<0.01zs傷前choroidopathy in detail1實(shí)驗資料取健康北京灰兔25只,體質(zhì)量2.5~3.2kg2討論實(shí)驗研究證明:外傷后眼球血液動(dòng)力學(xué)變化主要隨機分為4組,每組5只.高壓氣流沖擊傷組用北京產(chǎn)“燕牌有以下幾方面①影響血:視網(wǎng)膜屏障;②影響脈絡(luò )膜:視網(wǎng)膜高壓氣槍,射速204m,s-,不裝彈丸,槍口直接接觸角膜致屏障;③引起脈絡(luò )膜血管供血減少,導致組織細胞代謝紊亂;傷,其沖量0.02N,功能2.98J.鈍挫傷組用100g天平砝碼,①視網(wǎng)膜脈絡(luò )膜供血不足導致相應野視損害.距角膜40cm高處,對準兔眼自由落下,致傷兔眼的沖量為實(shí)驗中,非穿孔性外傷雖然無(wú)肉眼所見(jiàn)之視膜和脈絡(luò )膜28N.赤道部穿孔傷組于12點(diǎn)位距角膜緣7~8mm處,血管改變,致傷力也僅有0.02~0.28N,但由于高壓氣流的11號刀片垂直刺入,長(cháng)約3mm.角膜、睫狀體平部穿孔傷組沖擊作用,造成顯著(zhù)地眼內血管反應及眼組織生理學(xué)紊亂家兔10只,用11號刀片于右眼角膜正中刺入,房水流出,前輕度的沖擊傷,血流圖波幅值可出現反應性升高,然后迅速下房消失;同樣方法于左眼12點(diǎn)位距角膜緣4mm處刺入降,24h可恢復至傷前水平.眼底熒光血管造影未見(jiàn)滲漏.由上四組兔均采用硫噴妥鈉腹腔麻醉,50~80mg·kg·.傷前此可見(jiàn),輕度外傷在肉眼觀(guān)祭及熒光血管造影均未見(jiàn)異常改先行雙眼血流圖描記,測眼壓;傷后5,10,30min,1,4變時(shí)眼血流圖即有明顯的變化,它反映了輕度外傷眼血液動(dòng)48,72h,八個(gè)時(shí)間點(diǎn)做血流圖描記并測眼壓.1~3組傷前及力學(xué)變化早于臨床觀(guān)察,應當引起臨床工作者注意.多數學(xué)者認為眼球鈍挫傷可歸應于前后擠壓,眼球赤道傷后4,48h行眼底熒光血管造影.血流指數的計算方法,應部擴張導致網(wǎng)-脈絡(luò )膜血管牽拉供血障礙.其傷后血液動(dòng)力用 Jantch計算公式血流指數=E·100%04:血流圖學(xué)變化的特點(diǎn)是緩慢下降緩慢恢復,臨床過(guò)程較長(cháng),病理?yè)p波幅的高度(mm),εω:標準信號(Ω),E1標準信號高度(mm),害也較重R:電極間的眼阻抗(Ω).高壓氣流沖擊傷組傷前平均血流指三種不同部位的眼球穿孔傷對眼血液動(dòng)力學(xué)的影響以睫數為0.098‰,波幅值為0.01599,傷后5~10min內血流指狀體平部穿孔傷最大,血流圖波幅值和血流指數的恢復較慢數及波幅值短暫上升,10min后迅速下降,4h降至最低值,24說(shuō)明血-視網(wǎng)膜及脈絡(luò )膜屏障對外傷部位的反應各有其特性.h后恢復至傷前水平眼底熒光血管造影顯示動(dòng)靜脈期充盈和血流指數有密切關(guān)系.其改變的程度與眼壓下降幅度呈正比.但這只是一實(shí)驗現象,傷后眼壓改變多少方可引起血液指數和波幅值開(kāi)始下降,4~24h降至最低水平(由0.13%0動(dòng)力變化,即引起血液動(dòng)力學(xué)改變的眼壓閾值是多少,尚需進(jìn)0.45%‰;0.0239→0.002).48h后僅有一只眼恢復至傷前水平,4只眼于傷后4d恢復.眼底熒光血管造影顯示靜脈中國煤化工期及排空時(shí)間延長(cháng),未見(jiàn)脈絡(luò )膜及網(wǎng)膜血管出血和滲漏雙參YHCNMHG眼赤道部穿孔傷組由于傷后玻璃體流失,眼壓驟降,于傷后5[I] Tomic L, Macpea O, Sperber GO, Alm A. Comparison ofretinal transit times and retinal blood flow a study in monkeys收稿日期:2002-06-15;修回日期:2002-08-10[]. Invest Ophthalmol Vis Sci, 2001: 42(3): 752-755作者簡(jiǎn)介:王玉(1962-),女(漢族),安徽省蕭縣人.主治醫師.T編輯潘伯榮(010)66738929Ext,6196