激素联合脑苷肌肽及脱水药物治疗外伤性视神经损伤的临床分析

Clinical analysis of hormone combined with cerebral glycoside carnosine and dehydrating drugs in the treatment of traumatic optic nerve injury

目的回顾性分析外伤性视神经病变(traumatic optic neuropathg,TON患者应用激素联合脑苷肌肽及脱水药物治疗的效果。方法选取本院2014年2月到2021年9月期间285例TON患者,按照治疗方法不同分为联合组、常规组,分别为143例、142例。对比各组患者基线资料、治疗前后的视力恢复情况、不良反应,单因素分析两组预后良好以及视力改善的指标差异。结果联合组患者的视力恢复有效率明显高于常规组,差异有统计学意义(P<0.05);治疗后联合组患者的眼压以及视野平均缺损度均明显低于常规组,数据差异均具有统计学意义(P<0.05);单因素亚组分析结果显示年龄≤40岁、伤后残留光感、就诊时间≤24 h以及VEP未熄灭的TON患者联合应用激素与脑苷肌肽以及脱水药物治疗的视力改善效果与常规组的数据差异均具有统计学意义(P<0.05);单因素亚组分析结果显示有视神经管骨折、不伴有视神经肿胀迂曲的TON患者应用联合激素、脑苷肌肽以及脱水治疗的预后结局良好,与常规组的数据差异均有统计学意义(P<0.05)。结论脑苷肌肽与脱水治疗基础上联合激素甲泼尼龙琥珀酸钠治疗可以改善TON患者视力,减轻视神经损伤,并且不会增加不良反应发生风险,安全性较高,需重点关注年龄超过40岁、就诊时间超过24 h以及VEP熄灭、视神经肿胀等预后不良以及疗效差的高危患者,值得临床推广。

Objective To retrospectively analyze the effect of hormone combined with cerebral glycoside carnosine and dehydration drugs in traumatic optic neuropathy(TON)patients.Methods The enrolled 215 TON patients in our hospital from February 2014 to September 2021 were randomly divided into the combination group(n=143)and routine group(n=142).The baseline data,visual acuity recovery before and after treatment and adverse reactions of each group were compared.Univariate analysis was conducted to analyze the differences in indicators of good prognosis and visual acuity improvement between the two groups.Results The effective rate of vision recovery in the combination group was significantly increased than that in the routine group(P<0.05).After treatment,the intraocular pressure and visual field defect in the combination group were significantly decreased than those in the routine group(P<0.05).Univariate subgroup analysis showed that there were statistically significant differences between TON patients with age≤40 years,residual light sensation after injury,visit time≤24 h,and VEP not extinguished with combined treatment of hormone,brain glycoside carnotin and dehydrating drugs and the routine group(P<0.05).Univariate subgroup analysis showed that TON patients with optic canal fracture without optic nerve swelling and tortuosity had a good prognosis after treatment with combined hormone,cerebral glucoside carnosine and dehydration,which was statistically different from that in the routine group(P<0.05).Conclusions Brain glycosides carnosine and dehydration therapy on the basis of combined hormone a prednisolone sodium succinate treatment can improve vision in TON patients,lighten the optic nerve injury,will not increase the occurrence risk of adverse reactions,and have higher security.It is necessary to focus on high-risk patient over 40 years old,more than 24 h of treatment time,VEP extinction,optic nerve swelling poor efficacy.It is worthy of clinical promotion.