急性甲醇中毒性视神经病综合治疗探讨

Combined therapy for optic neuropathy induced by acute methanol poisoning

目的探讨急性甲醇中毒性视神经病的特点及综合治疗方法。方法对41例急性甲醇中毒出现中毒性视神经、视网膜损害的患者予血液透析、碳酸氢钠、脱水、维持酸碱电解质平衡,使用叶酸、激素、扩血管药改善脑血循及脑供氧.高压氧等综合治疗。结果41例中痊愈24例,轻度残损6例,重度残损7例,极重度残损4例(包括死亡1例)。结论急性甲醇中毒可引起不可逆的视神经损害,出现重度中毒性视神经病即预后差。尽快清除体内毒物,及时纠正酸中毒,早期、冲击剂量给予激素,防治脑水肿,改善眼底血循环及高压氧等综合治疗是抢救急性甲醇中毒并减少视功能障碍后遗症的重要手段。

Objective To explore the combined therapy for optic neuropathy induced by acute methanol poisoning. Methods Forty-one patients with optic nerve and retinal injury induced by acute methanol poisoning were treated with hemodialysis, sodium bicarbonate, and mannitol to maintain pH and electrolyte homeostasis, and methylprednisolone to decrease nerve cell edema. At the same time, high-pressure oxygen was used to improve brain oxygen supply. Nerve growth factor was applied to 5 patients. Results Of the 41 patients, 24 patients got recovery, 6 patients developed mild disability, 7 moderate disability, 4 severe disability （1 died）. Conclusion Acute methanol poisoning can induce irreversible optic nerve injury. Severe toxic optic neuropathy has a poor prognosis. Rapid clearance of methanol, acidosis correction, eyeground blood circulation improvement, hemodialysis and high-pressure oxygen treatment are all very important for the patients with acute methanol poisoning.