机动车事故致间接性视神经损伤的临床研究

Clinical study of indirect optic nerve injury caused by motor vehicle accident

目的探讨视神经损伤（opticnerveinjury，ONI）保守治疗中使用激素的疗效，视觉诱发电位（visualevokedpotential，VEP）在非手术治疗患者预后判断中的作用。方法北京同仁医院急诊外科收治的机动车事故致颅面部损伤患者253例，将其中89例符合条件的ONI患者随机分为两组：激素治疗组（A组）44例，使用甲强龙等治疗7d；非激素治疗组（B组）45例，不使用激素治疗7d。比较两组患者视力恢复等级及时间。89例患者均行VEP检查。结果两组患者性别、年龄、BMI差异无统计学意义（P〉0．05）。摩托车组ONI发生率高于汽车组（P〈0．01）；在摩托车事故中配戴头盔组ONI的发生率明显低于未佩带组（P〈0．01）。A组与B组治疗效果差异无统计学意义（P〉0．05）；两组黑朦患者视力恢复等级差异无统计学意义（P〉0．05）；但A组患者恢复时间早于B组（P〈0．01）。VEP对于判断ONI患者预后差异具有统计学意义；非熄灭型组视力有改善者治疗前后其振幅及潜伏期差异具有统计学意义（P〈0．叭）。结论摩托车事故致颅面部损伤是ONI的最主要原因。佩戴头盔能有效地降低摩托车事故所致ONI的发生率。应用激素对于患者最终预后在本实验中差异无统计学意义，激素的应用可缩短恢复时间但增加并发症的发生率。VEP是判断视ONI患者预后的有效手段；VEP中P波振幅及潜伏期的恢复与患者视力改善有非常密切的关系。

Objective To evaluate the curative effects of intravenous methylprednisolone （IVMP） during the conservative management for patients with indirect optic nerve injury （ ONI）, and to analyze the benefits of visual evoked potential （VEP） monitoring in prognosis assessment. Methods Among the 253 patients with cranial-facial injury, 108 sufferred from optic nerve injury including 89 cases without optic nerve decompression treatment. These 89 patients were randomly divided into： group A, in which patients were given methylprednisolone intravenously for 7 days; and group B, in which patients without methylprednisolone treatment. The extent of and time required for eyesight recovery were recorded. VEP measurement was carried out in all cases. Results No differences in gender, age and BMI （ Body Mass Index, all P 〉 0. 05） were observed. The incidence of ONI was higher in patients with motorcycle accident than that in those with car accident （P 〈0. O1 ）. In the motorcycle accidents, casualties wearing a helmet had lower incidence of ONI （ P 〈 0. O1 ）. Patients treated with methylprednisolone had a shorter recovery time （P 〈 0. 01 ） from blindness, however there was no difference in long-term outcome between group A and B. In patients with visual improvement in the ＂ non-extinguished＂ group, the amplitude and latency of the P wave of VEP were markedly ameliorated after the treatments （P 〈 0. 01 ）. Conclusions Most of the ONI casualties in our study were resulted from motorcycle accidents, and wearing a helmet is an effective protection measure. The intravenous methylprednisolone （IVMP） showed no effect on improving the prognosis in patients withconservative treatment. The IVMP shortened the recovery time at the expense of increase in risk of complications. VEP examination is beneficial in prognosis assessmenl for non-operalive ONI patients. The improvement of the amp]iimle an（t latency of P wave has close correlations with palienls＇visual recovery.