Fong L P
Department of Ophthalmology, University of Melbourne, Victoria, Australia.
Ophthalmology. 1994 Sep;101(9):1583-8. doi: 10.1016/s0161-6420(94)31134-1.
Treatment to decrease the rebleeding rate in traumatic hyphema remains controversial. Although antifibrinolytics recently have been shown to reduce secondary hemorrhage rates, their routine use has not been widely applied because of adverse side effects and the relatively low frequency of severe hyphema complications. Alternatively, their use may be restricted to patients at high risk, but prognostic factors for rebleeding have not been clearly identified.
From a prospective ocular trauma survey, 371 patients with traumatic hyphema were identified, and Fisher's exact test was applied to test for significant differences between patients who did and did not rebleed for various characteristics. Significant factors contributing to rebleeding were fitted into a multiple logistic regression model, and odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.
Secondary hemorrhage occurred in 8% of patients and was significantly more frequent in those with visual acuities of 20/200 or less (OR = 3.1; 95% CI = 1.3,7.5), initial hyphema more than one third of the anterior chamber (OR = 2.8; 95% CI = 0.9,8.0), delayed medical attention more than 1 day after injury (OR = 2.9; 95% CI = 1.0,8.4), and elevated intraocular pressure at time of first examination (OR = 2.9; 95% CI = 1.1,7.9). The secondary hemorrhage rate rose from 5% without any of these specified factors to 15% with at least one factor present. No statistical associations were found for age, injury-related iris abnormalities, or aspirin usage.
Using multivariate logistic regression in populations with low rates of secondary hemorrhage, a predictive model may be used to categorize patients who have higher rebleeding rates, for whom possible benefits may outweigh the risks of prophylactic treatment, and those with lower rebleeding rates, who may not necessarily benefit from treatment.
降低外伤性前房积血再出血率的治疗方法仍存在争议。尽管最近有研究表明抗纤溶药物可降低继发性出血率，但由于其副作用以及严重前房积血并发症相对较低的发生率，它们的常规使用尚未得到广泛应用。另外，其使用可能仅限于高危患者，但再出血的预后因素尚未明确。
从一项前瞻性眼外伤调查中，识别出371例外伤性前房积血患者，并应用Fisher精确检验来检测再出血患者与未再出血患者在各种特征方面的显著差异。将导致再出血的显著因素纳入多元逻辑回归模型，并计算比值比（OR）和95%置信区间（95%CI）。
8%的患者发生了继发性出血，视力在20/200或更低的患者中继发性出血明显更频繁（OR = 3.1；95%CI = 1.3，7.5），初始前房积血超过前房的三分之一（OR = 2.8；95%CI = 0.9，8.0），受伤后超过1天延迟就医（OR = 2.9；95%CI = 1.0，8.4），以及首次检查时眼压升高（OR = 2.9；95%CI = 1.1，7.9）。没有这些特定因素时继发性出血率为5%，至少存在一个因素时则升至15%。未发现年龄、与损伤相关的虹膜异常或阿司匹林使用情况与继发性出血之间存在统计学关联。
在继发性出血发生率较低的人群中使用多元逻辑回归，可采用预测模型对再出血率较高、预防性治疗可能利大于弊的患者，以及再出血率较低、不一定能从治疗中获益的患者进行分类。
