透明质酸或自体脂肪面部注射并发眼动脉及脑动脉阻塞临床研究

Clinical study of facial injection of hyaluronic acid or autologous fat with occlusion of ophthalmic artery and cerebral artery

目的观察透明质酸或自体脂肪面部注射并发眼动脉及脑动脉阻塞的临床特征,分析其发病机制,探讨治疗效果及预后。方法采用回顾性病例分析研究法,纳入2015年1月~2020年9月南阳市某院收治的21例透明质酸或自体脂肪面部注射后发生眼动脉及脑动脉阻塞患者,对其注射部位、注射物质、阻塞部位、临床症状、影像检查等临床资料进行分析。所有患者给予尿激酶溶栓、血管活性药物治疗,有肢体功能障碍者增加高压氧治疗,存在注射局部部位水肿、溃烂者增加局部透明质酸酶注射剂局部抗感染治疗。结果21例患者中,透明质酸注射16例(76.19%),自体脂肪注射5例(23.81%);注射部位在鼻唇部6例(28.57%),鼻部5例(23.81%),颞部3例(14.29%),眉间3例(14.29%),眶周2例(9.52%),额部2例(9.52%);单纯眼动脉阻塞7例(33.33%),单纯脑动脉阻塞5例(23.81%),眼动脉合并脑动脉阻塞9例(42.86%);合并注射部位水肿、缺血溃烂坏死7例(33.33%);核磁共振成像检查发现颅内新发缺血灶5例(23.81%)。经药物治疗及神经康复,3个月后随访,眼动脉阻塞者视力均无恢复,脑动脉阻塞者NIHSS评分及肢体功能明显改善,局部溃烂愈合,瘢痕评分(4.16±0.85)分。结论眼动脉及脑动脉阻塞是面部注射严重的并发症之一,经相应治疗后神经功能及局部血管并发症能够得到改善,但眼动脉阻塞导致失明较难治疗,因此,在面部注射时做好预防措施很关键。

Objective Observe the clinical characteristics of hyaluronic acid or autologous fat facial injection complicated by ophthalmic artery and cerebral artery occlusion.analyze its pathogenesis,and discuss the treatment effect and prognosis.Methods A retrospective case analysis method was used to enroll 21 patients with ophthalmic and cerebral artery obstruction after facial injection of hyaluronic acid or autologous fat who were admitted to a hospital in Nanyang from January 2015 to September 2020.Their injection site and injection Analyze clinical data such as substance,obstruction site,clinical symptoms,and imaging examination.All patients were treated with urokinase thrombolysis and vasoactive drugs.Patients with limb dysfunction were treated with hyperbaric oxygen therapy,and those with local injection edema and ulcers were treated with local hyaluronidase injection.Results Among 21 patients,16 cases were injected with hyaluronic acid(76.19%),5 cases were injected with autologous fat(23.81%);the injection site was in the nasolabial region in 6 cases(28.57%),the nose was in 5 cases(23.81%),and the temporal region 3 cases(14.29%),3 cases(14.29%)between the eyebrows,2 cases(9.52%)in the orbital area,2 cases(9.52%)in the forehead;7 cases(33.33%)in simple ophthalmic artery occlusion,and 5 cases in simple cerebral artery occlusion Of the 3 cases(23.81%),9 cases(42.86%)of ophthalmic artery complicated with cerebral artery obstruction;7 cases(33.33%)combined with injection site edema,ischemic ulceration and necrosis;MRI revealed 5 cases of new intracranial ischemic focus(23.81%).After medical treatment and neurological rehabilitation,3 months later,the eyesight of the patients with ophthalmic artery obstruction did not recover,the NIHSS score and limb function of cerebral artery obstruction patients were significantly improved,the local ulcers healed,and the scar score(4.16±0.85)points.Conclusion Ophthalmic artery and cerebral artery obstruction is one of the serious complications of facial injection.Neurological function and local vascular complications can be improved after corresponding treatment.However,blindness caused by ophthalmic artery obstruction is difficult to treat.Therefore,prevent it when injecting into the face.Measures are critical.