星状神经节阻滞对中心性浆液性脉络膜视网膜病变的疗效

The role of stellate ganglion block in central serous chorioretinopathy

目的观察星状神经节阻滞对合并脑血管痉挛的中心性浆液性脉络膜视网膜病变（csc）的疗效。方法回顾性病例对照研究。对经视力、眼底荧光素血管造影（FFA）、光学相干断层扫描（OCT）、Amsler表及眼前、后段检查确诊为CSC的患者行经颅多普勒（TCD）检查，筛查出合并患眼同侧大脑中动脉血流速度增快的患者70例，随机分为观察组和对照组。对照组予以口服改善微循环药物（B族维生素，维生素E，地巴唑，复方丹参滴丸药物治疗）；观察组在改善微循环药物基础上加行患眼同侧星状神经节阻滞治疗，隔日1次，连续4次为一疗程；于第1、2、4、8、12周记录两组患者的视力、眼底及FFA改变。应用卡方检验比较两组的总有效率。结果观察组的有效高峰时间为治疗后第2—4周，对照组的有效高峰时间为治疗后第8～12周，观察组较对照组的病程显著缩短。12周后观察组总有效率为94．4％，对照组为70．6％，两组疗效差异有统计学意义（Xz=-7．00，P〈0．05）。结论星状神经节阻滞可有效治疗合并脑血管痉挛的CSC。

Objective To observe the effect of stellate ganglion block on central serous choriorotinopathy （CSC） associated with cerebral vascular spasm. Methods This was a retrospective case control study. Seventy patients with ipsilateral middle cerebral artery eye spasm who had been diagnosed with central serous chorioretinopathy were screened by transcranial doppler （TCD） examination. Fundus fluorescein angiography （FFA）, optical coherence tomography （OCT）, Amsler grid and anterior and posterior segment examination were performed. The patients were then divided into an observation group and a control group. The control group was treated with traditional oral drugs to improve microcireulation （vitamin B, vitamin E, dibazol and compound danshen drops） and the observation group was treated with an oral stellate ganglion block to improve microcirculation. Treatment was given once on alternate clays and on 4 consequetive days during one span of the treatment period. Vision, fundus and FFA changes in the two groups of patients were compared at 1, 2, 4, 8 and 12 weeks. A chi square test was used to compare the total rate of effectiveness for the two groups. Results The total rates of effectiveness for the treatment and control groups were 94.4% and 70.6%. There was a statistically significant difference between the two groups （X2=7.00, P〈0.01）. The course of the treatment was shorter for the treatment group than for the control group. Conclusion Stellate ganglion block may be effective in the treatment of central serous chorioretinopathy associated with cerebral vascular spasm.