神经外科住院患者神经眼科临床特征分析

Analysis of the neuro -ophthalmic features for neurosurgery inpatients

目的探索和分析神经外科住院患者中与神经眼科相关的就诊疾病谱状况及临床特征,为今后开展神经眼科的相关研究和防治策略提供科学依据。方法前瞻性病例研究。连续纳入解放军总医院2012年1月1日至2012年6月30日神经外科病房住院患者,对所有患者进行眼科筛查,对有眼科主诉及客观检查异常的患者进行系统神经眼科检查。结果共纳入神经外科住院患者1 213例,其中213例(17.6%)患者出现神经眼科相关临床表现。神经眼科临床表现中以持续性视力下降(84.5%)、视野缺损(88.1%)、相对性瞳孔传入障碍(29.6%)和视神经萎缩26例(12.2%)最为常见。与神经眼科表现相关的主要病因是肿瘤(86.4%)和颅内血管源性病变(13.1%)。病变部位以蝶鞍区最多(78.4%),其中累及的部位依次为垂体(61.1%)、蝶窦(18.6%)、海绵窦(7.2%)、鞍结节(3.0%)。结论神经眼科体征对指导神经外科疾病的诊治具有重要意义,最常见的临床症状和体征是持续性的视力下降、视野缺损、相对性瞳孔传入障碍、视神经萎缩;神经眼科涉及范围广泛,应针对性探讨神经眼科相关疾病的诊疗规范和可能干预策略。

OBJECTIVE To analyse the neuro-ophthalmic clinical features of neurosurgery inpatients. METHODS Prospective case serials. The continuous inpatients in Neurosurgery Department of PLA General Hospi- tal from Jan 1, 2012 to July 30, 2012 were screened prospectively. The patients who had ocular complaints and ab- normalities experienced the neuro-ophthalmic examination then. RESULTS A total of 1 213 were investigated, 213 （ 17.6% ） associated with neuro-ophthalmic signs. The neuro-ophthalmic of clinical manifestations with persistent vision loss （84.5%）, visual field loss （88.1%）, RAPD （29.6%） and optic atrophy （12.2%） were the most common. The leading causes were intracranial tumors （86.4%） and intracranial vascular disease. Lesions in sellar region （78.4%） were the most common locations, in which the pituitary （61.1%）, sphenoid （18.6%）, cavernous sinus （7.2%） and tubereulum sellae （3.0%） were mostly associated. CONCLUSIONS Nuro-ophthalmic signs are con- tributive to determine locations of neurosurgic disease. The most common clinical signs and symptoms were persistent decreased visual acuity, visual field defects, RAPD, and optic atrophy. Related disease diagnostic and treatment practices and possible intervention strategies should be established.