重型颅脑损伤患者视神经损伤的早期诊断和治疗

The Early Diagnosis and Treatment of Optic Nerve Injury in the Patient with Serve Craniocerebral Trauma

目的探讨重型颅脑损伤患者视神经损伤的早期诊断和治疗。方法总结23例重型颅脑损伤伴发视神经损伤患者的临床资料,就视神经损伤的早期瞳孔变化、早期诊断、治疗及预后进行分析。结果23例患者均有患侧瞳孔异常,但入院时患侧瞳孔直接对光反应消失、间接对光反应正常仅7例;视神经损伤伤后3天内确诊率56.5%(13/23),7天内确诊率91.3%(21/23);21例行保守治疗,2例行手术治疗。伤后1～3月视力恢复情况:能见视力(>0.05)30.4%(7/23),光感、眼前手动、眼前指数39.1%(9/23),失明30.4%(7/23)。结论对重型颅脑损伤患者,重视瞳孔变化的动态观察,早期发现伴发的视神经损伤并及时治疗,可使部分患者恢复视功能,减少失明。

Objective To approach the early diagnosis and treatment of optic nerve injury in the patient with serve craniocerebral trauma.Methods Clinical data of 23 cases were summarized about optic nerve injury associated with serve craniocerebral trauma, the early change of pupils and the early diagnoses and the treatment and the prognoses of optic nerve injury were analysed.Results All pupils being injured of 23 cases wrere abnormal,but only 7 cases showed indirect and no direct reaction to light at the time of hospitalization.The rate of confirmed diagnoses of optic nerve injury was 56.5% （13/23）within 3 days and 91.3% （21/23）within 7 days.21 cases were conservative treatment,2 cases operative treatment.The recovery of sight were visible （〉0.05）30.4% （7/23）,light perception and hand movement and counting figures 39.1%（9/23） ,blind 30.4% （7/23）.Conclusion In the patients with serve craniocerebral trauma,it was necessary to pay attention to observe the change of pupils. If optic nerve injury associated with serve craniocerebral trauma could be discovered in time and treaded without delay,it would make a part of patients to regain good sight and not to go blind.