低分子肝素钠治疗前部缺血性视神经病变疗效观察

Therapeutic effect of low molecular weight heparin （LMWH） on anterior ischemic optic neuropathy （AION）

目的 观察低分子肝素钠治疗前部缺血性视神经病变的疗效.方法 临床病例系列研究.对2010年5月至2013年10月在河北大学附属医院眼科经临床确诊的前部缺血性视神经病变患者80例86只眼,分为治疗组（40例44只眼）和对照组（40例42只眼）,2组均接受常规治疗,包括静脉滴注长春西汀、辅酶A、ATP,球后注射地塞米松、盐酸消旋山莨菪碱注射液、利多卡因注射液,配合维生素B1、甲钴胺片口服,14 d为1个疗程.治疗组在常规治疗的基础上加用低分子肝素钠5 000单位腹壁脐周皮下注射,1次/d,连用14 d.两组患者用药后每天观察视力、眼底变化,治疗前有视野检查者复查视野.结果 治疗组治疗后的视力、视野均较治疗前明显提高,差异有统计学意义（分别为t =3.363,2.858,P=0.002和0.007,P＜0.05）;治疗组视力提高的总有效率及显效率均高于对照组,两组间差异有统计学意义（χ^2=7.63,P=0.006,χ^2=4.63,P=0.034,P＜0.05）.治疗组视野改善的总有效率及显效率均高于对照组,两组间差异有统计学意义（χ^2=9.77,χ^2=5.05,P=0.0314 P=0.025,P＜0.05）.结论 低分子肝素钠治疗前部缺血性视神经病变能明显提高疗效,改善视功能.

Objective To observe the therapeutic effect of low molecular weight heparin on anterior ischemic optic neuropathy （AION）.Methods Eighty patients （86 eyes） diagnosed as with AION were divided into treatment group （40 patients,44 eyes） and control group （40 patients,42 eyes）.The two groups both received injection of Ainpocetine,Coenzyme A and ATP,retrobulbar injection of dexamethasone,anisodamine and lidocaine.All the patients took vitamin B1 and mecobalamine,14 days were as one treatment course.The treatment group voluntarily infused abdominally subcutaneously with 5000u LMWH every day for 14 days on the basis of conventional treatment.The changes of visual acuity and ocular fundus of the patients after injection were recorded,and the visual field was counterchecked in the patients who had underwent the examination before the treatment.Results After treatment,visual acuity,visual field of the treatment group were significantly increased compared with before treatment.About the visual acuity improvement the total effective rate and the obviously effective rate was both higher in treatment group than which in control group with a significant difference （P ＜0.05）.About the visual field improvement the total effective rate and the obviously effective rate was both higher in treatment group than which in control group with a significant difference （P ＜0.05）.Conclusions Low molecular weight heparin can obviously improve the clinical effect and visual function of anterior ischemic optic neuropathy patients.