颈内动脉狭窄伴眼部缺血性表现的临床特征和疗效观察

Clinical features and therapeutic effect of carotid artery stenosis associated with ocular ischemic appearance

目的探讨颈内动脉狭窄伴眼部缺血性表现患者的临床特征和治疗效果。方法回顾性分析齐齐哈尔医学院第五临床医学院眼科2011年12月至2012年12月期间71例(71只眼)颈内动脉狭窄伴眼部缺血性表现患者的临床资料,描述患者颈内动脉狭窄伴眼部缺血性情况。因为对疗效数据为有序数据,故采用Kruskal-Wallis H秩和检验的方法进行比较。以P<0.05为差异有统计学意义。当差异有统计学意义时,对3组之间的疗效进行两两比较。结果 71例患者中,一过性黑矇者33例(33只眼),眼前闪光者25例(25只眼),眼部红肿伴有眼眶周围疼痛者23例(23只眼),复视者7例(7只眼),视力下降者4例(4只眼)。27例眼部缺血性疾病确诊患者中,缺血性视神经病变者8例(8只眼),眼部缺血综合征者55例(55只眼),视网膜中央分支动脉阻塞者6例(6只眼),视网膜出血者4例(4只眼),眼外肌麻痹者3例(3只眼),新生血管性青光眼1例(1只眼),颈内动脉狭窄程度和眼部缺血性疾病的发生率呈高度正相关。单纯药物治疗后显效者2只眼(13.3%),有效者4只眼(26.7%),无效者9只眼(60.0%),总有效率40.0%;颈内动脉内膜切除术后显效者10只眼(43.5%),有效者11只眼(47.8%),无效者2只眼(8.7%),总有效率91.3%;颈内动脉支架置入术后显效者11只眼(47.8%),有效者8只眼(34.8%),无效者4只眼(17.4%),总有效率82.6%,采取颈内动脉支架置入术和颈内动脉内膜切除术的治疗效果明显优于单纯药物治疗,差异有统计学意义(Hc=9.60,7.68;P=0.002,0.006)。结论颈内动脉狭窄伴眼部缺血性表现的患者,临床特征较为多样,可出现多种眼部缺血性疾病,行颈内动脉支架置入术或颈内动脉内膜切除术,可获得较好的临床治疗效果。

Objective To investigate the clinical characteristics and therapeutic effect of carotid artery stenosis associated with ocular ischemic appearance.Methods A total of 71 cases ( 71 eyes ) of carotid artery stenosis associated with ocular ischemia from Dec.2011 to Dec.2012 in Department of Ophthalmology,the Fifth Affiliated Hospital of Qiqihar Medicical University were retrospectively analyzed. The degree of carotid artery stenosis and ocular ischemic appearance were described.Therapeutic effect was ordered data and it was evaluated by Kruskal-Wallis H rank sum test.Difference was statistically significant when P<0.05.Results Ocular symptoms were observed in all 71 cases, including amaurosis fugax in 33 cases (33 eyes),flash before the eye in 25 cases (25 eyes),periorbital swelling and pain in 23 cases (23 eyes),diplopia in 7 cases (7 eyes) and vision loss in 4 cases (4 eyes).There were 27 cases diagnosed with ocular ischemic diseases, including ischemic optic neuropathy in 8 cases ( 8 eyes ) ocular ischemic syndrome in 5cases (5 eyes),central or branch retinal artery occlusion in 6 cases (6 eyes), retinal hemorrhage in 4 patients ( 4 eyes ) , extraocular muscle paralysis in 3 patients ( 3 eyes ) and neovascular glaucoma in 1 patients (1 eye).There was a high-positive correlation between the degree of carotid stenosis and the incidence of ocular ischemic disease.In simple drug treatment group, 2 eyes ( 13.3%) were markedly effective,4 eyes (26.7%) were effective and 9 eyes (60.0%) were in vain.The total efficiency was 40.0%.In carotid endarterectomy group,10 eyes (43.5%) were markedly effective,11 eyes (47.8%) were effective and 2 eyes (8.7%) were in vain.The total efficiency was 91.3%.In carotid artery stenting group,11 eyes (47.8%) were markedly effective,8 eyes (34.8%) were effective and 4 eyes (17.4%)&nbsp;were in vain.The total efficiency was 82.6%.The theraputic effect of carotid artery stenting and carotid endarterectomy was significantly better than that of drug treatment alone, the difference was statistically significant (Hc=9.60,7.68;P=0.002,0.006).Conclusions Cartery stenosis associated with ocular ischemic appearance has diversified clinical manifestations.It can be complicated by many kinds of ocular ischemic diseases.Carotid artery stenting and carotid endarterectomy were effective treatment.