眶内电针治疗颅脑外伤后动眼神经麻痹的疗效及相关因素分析

Efficacy of intraorbital electroacupuncture for oculomotor nerve palsy after head trauma and its influencing factors

目的回顾眶内电针治疗颅脑外伤后动眼神经麻痹的病案,分析影响疗效的相关因素。方法回顾性分析于我院接受眶内电针治疗的头外伤后动眼神经麻痹患者临床资料,使用多因素分析等方法对性别、年龄、颅脑损伤程度、动眼神经麻痹程度、眼运动神经麻痹评分、病程、治疗次数等可能影响疗效的因素进行分析。结果 90例患者中痊愈24例,显效及有效共46例,无效20例,总有效率77. 8%。患者眼运动神经麻痹各项评分均明显减小,差异有统计学意义(P均<0. 001);其中眼睑运动和水平内收较下视运动、瞳孔散大及光反射改善明显。回归分析:GCS严重程度、病程为针灸有效的危险因素,(β=-3. 835,P=0. 016;β=-4. 618,P=0. 049)治疗次数为保护因素(β=0. 406,P=0. 006);病程>90天的患者疗效差,针灸有效的可能性低,为≤90天的1/100 (P <0. 05)。结论眶内电针可有效治疗头外伤后动眼神经麻痹,其中眼外肌较眼内肌恢复更好。其有效性受颅脑损伤程度,病程和治疗次数影响,GCS评分重,病程长、治疗次数少者针灸有效的可能性低。

Objective To review the cases of oculomotor nerve palsy after head trauma treated with intraorbital electroacupuncture( IEA),and to analyze the influencing factors for treatment outcomes. Methods A retrospective analysis was performed on the clinical data of the patients with oculomotor nerve palsy after head trauma who underwent IEA in our hospital. Multivariate analyses were performed on the possible factors influencing treatment outcomes,such as sex,age,severity of traumatic brain injury,level of oculomotor nerve palsy,oculomotor nerve palsy score,course of the disease,and times of treatment. Results In the 90 patients enrolled as subjects,24 were cured,46 had response or marked response,and 20 had no response,yielding an overall response rate of 77. 8%. The patients had significantly reduced scores for each item in oculomotor nerve palsy after treatment( all P 0. 001). Particularly,ptosis and horizontal adduction were significantly improved compared with eyeball downward movement,pupil dilation,and light reflex. According to the regression analysis,Glasgow Coma Scale( GCS) severity and course of the disease were risk factors for treatment outcomes(β=-3. 835,P = 0. 016;β=-4. 618,P = 0. 049);times of treatment was a protective factor for treatment outcomes(β=0. 406,P = 0. 006). Those patients with a disease course over 90 days had a low response rate after treatment,which was only 1/100 of that of the patients with a disease course not longer than 90 days( P 0. 05). Conclusions IEA is an effective therapy for oculomo-tor nerve palsy after head trauma. Particularly,IEA heals the extraocular muscles better than the intraocular muscles. The treatment outcomes depend on the severity of traumatic brain injury,course of the disease,and times of treatment. A high GCS score,long duration of the disease,and few treatments reduce the patients' response to IEA.