增强型体外反搏辅助治疗非动脉炎性前部缺血性视神经病变的疗效观察

The observation of curative effect of enhanced external counter pulsation as an adjunctive therapy for nonarteritic anterior ischemic optic neuropathy

【摘要】目的观察增强型体外反搏（EECP）辅助药物治疗非动脉炎性前部缺血性视神经病变（NAI（）N）的临床效果和安全性。方法回顾性病例对照研究。临床确诊为NAION的48例患者48只眼纳入研究。其中，有出血性疾病、严重的主动脉瓣关闭不全、主动脉瘤及夹层动脉瘤、肢体有血栓性静脉炎或感染病灶及不能控制的严重高血压等EECP治疗禁忌的32例32只眼行单纯扩张血管及营养神经药物治疗（药物治疗组）；无EECP治疗禁忌的16例16只眼在扩张血管及营养神经药物治疗的基础上，同时行EECP治疗（EECP治疗组）。两组患者性别（x2=0．000）、年龄（t=1．096）、病程（t=1．613）及视力（t=0．000）比较，差异无统计学意义（P〉0．05）。EECP1次／d，1h／次，每周治疗5d。EECP治疗组患者中，行12次治疗者14例，行36次治疗者2例。观察EECP治疗组患者治疗期间全身及眼部副作用的发生情况。治疗后所有患者行矫正视力检查，对比分析EECP治疗6、12次时，药物治疗组与EECP治疗组患者视力恢复程度的差异以及所有患者视力恢复程度与病程、治疗前视力的相关性。其中，以矫正视力较治疗前提高≥3级为显效，视力较治疗前提高≤2级为有效，视力较治疗前无进步甚至下降为无效。结果EECP治疗6次时，EECP治疗组16只患眼中，视力显效2只眼，有效5只眼，无效9只眼；药物治疗组32只患眼中，视力显效3只眼，有效8只眼，无效21只眼。两组视力恢复程度比较，差异无统计学意义（x2=0．404，P〉0．05）。EECP治疗12次时，EECP治疗组16只患眼中，视力显效6只眼，有效9只眼，无效1只眼；药物治疗组32只患眼中，视力显效4只眼，有效10只眼，无效18只眼。两组视力恢复程度比较，差异有统计学意义（x2=11．62l，P〈0．05）。所有患者视力恢复程度与病程呈负相关（r=-0．860，P〈0．05），与治疗前视力呈正相关（r=-1．380，P〈0．05）。EECP治疗组患者在治疗期间均未发生皮肤擦伤、血肿、新的视网膜出血等副作用。结论多次EECP辅助药物治疗较单纯药物治疗更有助于提高NAION患者视力恢复。但需要一定次数的重复治疗；未见局部及全身副作用。

Objective To observe the efficiency and security of enhanced external counter pulsation （EECP） as an adjunctive therapy for nonarteritic anterior isehemic optic neuropathy （NAION）. Methods This was a retrospective case-control study. Forty-eight patients （48 eyes） with NAION were enrolled in this study. Thirty-two patients （32 eyes） who had been treated with blood vessel dilation and nerve nutrition drugs comprised the medicated group. Sixteen of the patients （16 eyes） in the medicated group were treated with EECP combined with blood vessel dilating and nerve nutrition drugs as EECP group. The differences were not statistically significant between groups in gender（z2 =0. 000）, age （t=1. 096）, course （t=l. 613） and visual acuity （x2=0. 000, P〈0.05）. EECP was done once a day, one hour per time, five times a week. Fourteen eyes were treated 12 times EECP and two eyes were treated 36 times EECP within the EECP group. Systemic and ocular side effects were observed during EECP treatment. Corrected visual acuity was examined after treatment and the differences of visual acuity between medicated group and EECP group treated six times and or 12 times with EECP treatment were analyzed. The correlation of visual acuity level, and course, and acuity before treatment were analyzed. A significant improvement in visual acuity was defined as a sustained improvement of three or more visual acuity gradations. An effective of treatment was defined as a sustained improvement of two or less visual acuity gradations. No effective of treatment was defined as visual acuity dropped or showed no progress. Results After six treatments of EECP, within the 16 eyes of EECP group, two eyes achieved significant improvement, five eyes had effective improvement, and nine eyes did not show any improvement. Within the 32 eyes of medicated group, three eyes achieved significant improvement, eight eyes had effective improvement, and 21 eyes did not show any improvement. There was no statistically significant difference in vision between the two groups （X2= 0. 404, P〈 0.05）. After 12 treatments of EECP, within the 16 eyes of EECP group, six eyes achieved significant improvement, nine eyes had effective improvement, and one eye did not show any improvement. Within the 32 eyes of medicated group, four eyes achieved significant improvement, 10 eyes had effective improvement, and 28 eyes did not show any improvement. The difference was statistically significant comparing the vision level Between the two groups （X2 =11. 621, P〈0.05）. The curative effect of patients negatively correlated with course of the disease （r= -0. 860, P〈0.05）, but positively correlated with visual acuity before treatment （r=1. 380, P〈0.05）. Skin bruises, hematoma, new retinal bleeding and other side effects did not occur in patients during EECP treatment. Conclusions Many-time therapy of EECP can improve vision of NAION patients. There is no local and general complications after a certain number of therapy.