目的：分析曲安奈德在玻璃体切割术治疗增殖性糖尿病视网膜病变(PDR)中的止血作用及机制。

方法：将2013-01/2014-03于我院因PDR进行治疗的400例800眼患者作为研究对象。将所有患者按照治疗方式进行分组，其中对照组直接行玻璃体切割术治疗，观察组在术前4～14d注射曲安奈德后行玻璃体切割术治疗。对比两组患者术后尿激酶纤溶酶原激活物(u-PA)、组织纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制剂(PAI-1)等凝血相关因子的表达水平及术中、术后并发症的差异。

结果：观察组u-PA、t-PA表达水平显著低于对照组，而PAI-1表达水平显著高于对照组(P<0.01)； 观察组手术时间、术中出血量均显著低于对照组(P<0.01)； 观察组术中剥膜出血发生率显著低于对照组(P<0.05)； 术后黄斑水肿发生率显著低于对照组(P<0.01)。

结论：PDR患者采用玻璃体切割术常伴随有出血和各类并发症，曲安奈德可通过对患者玻璃体腔内多项凝血因子水平进行调节，从而直接发挥止血作用，减少出血量，可增加手术安全性，减少并发症发生率。

METHODS: Totally 400 patients were treated in our hospital for PDR between January 2013 and March 2014. All subjects were divided into groups. The control group was treated with vitrectomy directly. The observation group was treated with triamcinolone acetonide at 4-14d before surgery. The differences of the indexes and complications in postoperative vision correction were compared between the two groups.

RESULTS: The expression levels of u-PA, t-PA and PAI-1 in the observation group were significantly higher than those in the control group(P<0.01). The operation time and blood loss during the observation period were significantly lower in the observation group than in the control group(P<0.01). The incidence of retinal breaks and vitreous hemorrhage in the group was significantly lower than that in the control group(P<0.05). The incidence of macular edema after the operation was significantly lower than that in the control group(P<0.01).

CONCLUSION: Vitrectomy in patients with PDR is often accompanied by hemorrhage and various complications. The use of triamcinolone acetonide can regulate the level of multiple clotting factors in the vitreous cavity of the patient, thereby reducing the amount of bleeding or directly exerting hemostasis, increasing surgical safety, reducing the incidence of complications, which is worthy of clinical application.