【摘要】 目的观察眼部热金属烧伤的临床特点及治疗方式。方法回顾性分析山东省眼科医院2004年9月至2012年12月因眼部热金属烧伤入院的患者47例(54只眼),对烧伤部位的临床特点,热金属种类、烧伤程度、面积之间的关系,远期并发症及治疗结果进行小结。结果眼部金属热烧伤有以下临床特点:(1)烧伤主要局限于热金属直接作用的部位:球结膜局限性缺血坏死面积小于1/4者25只眼(56.8%),21只眼位于下方;(2)金属直接作用于角膜的部位有较为严重的组织自溶:26只眼(48.2%)角膜自溶中20只眼位于下方近角膜缘处,具有面积小、深度深、溶解快的特点;(3)眼睑烧伤多见:角膜、结膜受损的同时伴有眼睑烧伤48只眼(88.9%),29只眼睑板糜烂坏死留有瘢痕;(4)不同温度的热金属(铁水和铝水)对角膜的损伤程度差异无统计学意义(卡方=0.926,P>0.05);(5)烧伤后6周眼表是否稳定与结膜、角膜损伤面积的大小有关(卡方=4.456,P<0.05;卡方=8.145,P<0.01);(6)远期并发症中睑球粘连的发生率较高,25只眼,占55.6%。治疗结果:(1)18只眼(37.5%)因眼睑缺损、眼球暴露影响眼表稳定行永久性睑裂缝合术;(2)早期(3 d内)是否行羊膜移植术与角膜自溶的发生有关(卡方=5.035,P<0.05)。结论高温热金属对眼部的损伤主要局限于金属直接作用的下方球结膜及角膜,随病情发展有严重的组织自溶。烧伤程度与热金属的温度无关,烧伤面积的大小影响愈合程度。早期羊膜移植术可缓解烧伤程度。伴有眼睑的烧伤较多,永久性睑裂缝合术可有效改善眼睑缺损、眼球暴露。更多还原

【Abstract】 Objective To investigate the clinical characteristics and treatment methods for ocular thermal burns by hot metal liquid.Results There were 47 patients(54 eyes) with ocular thermal burns by hot metal liquid admitted to Shandong Eye Hospital between September 2004 and December 2012.Histories of these patients were analyzed retrospectively.The clinical characteristics of the burns,types of the metal,degree of injuries to the eye,relationship between burned areas and longPterm complications and treatment outcomes were analyzed.Results Eye metal thermal burns has the following clinical features:(1) Burns were mainly limited to the area of hot metal direct contact:focal conjunctival ischemic necrosis were less than a quarter in 25 eyes(56.8%),and in 21 eyes,it located in lower part of the conjunctiva.(2) Severe tissue autolysis were found at the part of the cornea that had direct metal contact:in 20 out of 26 eyes which had the cornea autolysis,it located near the limbus,and was small,deep,and fast resolved.(3) Eyelid burns were more common:in 48 eyes damaged corneal or conjunctival accompanied with eyelid injuries(88.9%),and in 29 eyes the eyelid plate progressed to local erosive necrosis and scar formation.(4) There was no significant difference in the degree of corneal injury caused by burns with metals of different temperatures(e.g.,molten iron or molten aluminum,chi-square = 0.926; P > 0.05).(5) The stability of ocular surface at 6 weeks after burns was related to the injury size in conjunctiva(chipsquare =4.456,P <0.05) and cornea(chi-square = 8.145,P <0.01).(6) There was a higher incidence of symblepharon(25 eyes,55.6%).Regarding the therapeutic outcome:(1) 18 eyes(37.5%) received permanent tarsorrhaphy because of damaged eyelid and consequently eyeball exposure.(2) Whether corneal autolysis would occur was linked to whether early(within 3 days) amniotic membrane transplantation was performed(chi-square = 5.035,P < 0.05).Conclusion The ocular injury by high temperature metal is mainly limited to the area on conjunctiva and/or corneal with direct contact.Severe tissue autolysis may occur in later phase.The degree of injuries is not related to the temperature of the metal,while the size of burns area affects healing.Early amniotic membrane transplantation improves outcomes.Accompanied eyelid burns may require permanent palpebral fissure surgeries to correct the eyelid deformation and eyeball exposure.更多还原