前部缺血性视神经病变的综合治疗临床观察

Clinical observation of comprehensive treatment on anterior ischemic optic neuropathy

目的：观察综合治疗前部缺血性视神经病变的临床疗效。方法收集2014年1月至2015年6月来山西医科大学第一附属医院就诊的前部缺血性视神经病变患者40例（42眼）作为研究对象。所有患者均积极治疗全身疾病，同时全身及局部给予激素、扩血管、神经营养药物以及颞浅动脉旁注射复方樟柳碱等综合治疗，以15d为一个疗程，随访观察30～45d。结果40例（42眼）患者中，男25例，女15例；发病年龄42～71岁，平均为55.52岁，伴高血压病者24例、糖尿病者10例、高脂血症者22例，有吸烟史者18例。就诊时间最短者2d，最长者1个月，平均11.48d。40例（42眼）患者治疗15d后视力有显著提高（P＜0.01），随访观察30～45d后视力较治疗15d时提高（P=0.029）；治疗前平均视野缺损值为（16.14±5.05）dB，治疗15d后平均视野缺损值为（11.56±3.74）dB，明显降低（t=12.63，P＜0.01），随访观察30～45d时平均视野缺损值（9.53±3.89）dB，较治疗15d时降低（t=8.94，P＜0.01）；随访观察30～45d后总有效率（90.48%）与治疗15d时总有效率（78.57%）比较，P=0.113，尚不能认为差异有统计学意义。结论综合治疗前部缺血性视神经病变的临床疗效显著，能有效提高患眼视力，降低视野缺损，明显减轻视盘水肿程度。

ObjectiveTo observe the clinical effect of comprehensive treatment of anterior ischemic optic neuropathy.MethodsFrom January 2014 to July 2015, 42 eyes of 40 patients with anterior ischemic optic neuropathy in First Hospital of Shanxi Medical University were used as the research objects. All the patients were actively controlled systemic disease, at the same time given systemic and local comprehensive therapies, such as glucocorticoid hormone, vasodilator, neurotrophic drugs and compound anisodine injected around superficial temporal artery, with 15 days for a course of treatment, then followed up for 30-45 days.ResultsIn 40 cases （42 eyes） of the patients, 25 males and 15 females, the age ranged from 42 to 71 years with an average age of 55.52 years. Among them, 24 patients were hypertension, 10 patients with diabetes, 22 patients with hyperlipidemia, and 18 patients with a history of smoking. The shortest time was 2 days, the longest was 1 month, and the average was 11.48 days. Visual acuity of 42 eyes was improved significantly after 15 days treatment （P〈0.01）. After a follow-up observation of 30-45 days, visual acuity improved more significantly than 15 days treatment （P=0.029）. Before treatment the mean visual field defect was （16.14±5.05） dB, but it was （11.56±3.74） dB after 15 days treatment, which was significantly reduced （t=12.63,P〈0.01）. Then after a 30-45 days follow-up observation, the mean visual field defect was （9.53±3.89） dB, lower than 15 days treatment （t=8.94, P〈0.01）. Compared the total effective rate of 90.48% （30-40 days follow-up observation） with 78.57% （15 days treatment）, it was not considered to be statistically significant （P=0.113）.Conclusion The＆amp;nbsp;comprehensive treatment of anterior ischemic optic neuropathy has a significant effect, can effectively improve the vision, reduce the field defect and significantly reduce the optic papilla edema.