复杂性视网膜脱离行玻璃体切割联合硅油填充术患者延续管理的效果

Application Effect of Continuous Management in the Treatment of Patients with Complicated Retinal Detachment by Vitrectomy Combined with Silicone Oil Filling

摘要: 目的：分析延续管理模式在提高复杂性视网膜脱离行玻璃体切割联合硅油填充术患者治疗依从性、视网膜复位率、改善并发症及提升就医体验等方面的效果。方法：采用整群随机抽样法抽取2019年1月~12月某部队三级甲等医院眼科由同一手术医生所做的98例(98眼)复杂性视网膜脱离行玻璃体切割联合硅油填充术患者作为研究对象，随机分为干预组和对照组各49例(49眼)。对照组实施常规专科住院期间管理 + 出院随访，干预组在此基础上接受出院后3~6个月内以硅油取出为止的延续管理，比较两组患者一次性手术视网膜复位率、并发症发生情况、治疗依从性及就医体验。结果：1) 干预组一次性手术视网膜复位率高于对照组，差异有统计学意义(P < 0.05)。2) 并发症：干预组高眼压及便秘发生率均低于对照组(P < 0.05)，干预组感染性眼内炎发生率低于对照组但无差异(P > 0.05)，干预组总体并发症发生率低于对照组，差异有统计学意义(P < 0.05)；3) 干预组治疗依从性评分优于对照组，差异有统计学意义(P < 0.05)；4) 干预组就医体验评分明显低于干预前及低于对照组，差异有统计学意义(P < 0.05)。结论：延续管理模式在玻璃体切割联合硅油填充术治疗复杂视网膜脱离患者中的实施，可有效提高患者的治疗依从性，提升患者一次性手术视网膜复位率，降低患者各类并发症发生率，患者就医体验提升。

Abstract: Objective: To analyze the effect of the continued management model on improving the treatment compliance, retinal reattachment rate, improvement of complications and patient experience in patients undergoing vitrectomy combined with silicone oil filling surgery for complex retinal detachment. Methods: From January to December 2019, 98 patients (98 eyes) with complex retinal detachment and vitrectomy combined with silicone oil filling were selected by the same surgeon, were randomly divided into intervention group and control group in 49 cases (49 eyes). The control group implemented routine specialist hospitalization management and discharge follow-up. On this basis, the intervention group received continued management until silicone oil was taken out within 3 to 6 months after discharge. The two groups were compared with one-time surgical retinal reattachment rates and complications, treatment compliance and medical experience. Results: 1) The rate of one-time retinal reattachment in the intervention group was higher than that in the control group (P < 0.05); 2) Complications: The incidence of high intraocular pressure and constipation in the intervention group were lower than those in the control group (P < 0.05), The incidence of infectious endophthalmitis in the control group was lower than that of the control group but no difference (P > 0.05). The incidence of complications in the intervention group was lower than that of the control group (P < 0.05); 3) The intervention group’s treatment compliance score is better than the control group (P < 0.05); 4) The intervention group’s medical experience score was significantly lower than the control group (P < 0.05). Conclusions: The implementation of the continued management model in the treatment of patients with complicated retinal detachment by vitrectomy combined with silicone oil filling can effectively improve the patient’s treatment compliance, increase the patient’s one-time operation retinal reattachment rate, reduce the incidence of complications, and improve the patient’s medical experience.