外伤性视神经病变手术与大剂量皮质激素治疗的评价.doc

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1、外伤性视神经病变手术与大剂量皮质激素治疗的评价夕卜伤性视神经病变手术与人剂量皮质激素治疗的评价马志屮刘饮城魏少波王荣光张卯年黄一飞李朝晖【摘要】的评价视神经减压术与人剂量皮质激素对外伤性视神经病变的治疗作川和影响预后的相关因索。方法外伤性视神经病变40例40只眼，14例施行经颅、经鼻窦内窥镜和经眶筛途径视神经减压术；11例应用人剂量皮质激索(地塞米松15例，甲泼尼龙30mg/kg6例)治疗；15例在院外釆用自选非特殊疗法治疗。根据最终视力和治疗后近期视力变化，评价于术、人剂暈皮质激素和非特殊疗法治疗的疗效，并通过多因索分析筛选影响视力预后的相关因索。结果40例患者中最终视力无光感者19例，占4

2、7.5%；光感〜0.02者12例，占30.0%；0.05以上者9例，占22.5%。人剂量皮质激索治疗组的优势比为2.96(P二0.0125),最终视力明显好于手术治疗组(P=0.005)和非特殊治疗组(P=0.023)；治疗后近期有效率比于术治疗组高("0.024)。伤后无光感比有光感以上视力对最终有无视力恢复的危险度增加2・14倍(P二0.0349)。结论人剂量皮质激素对外伤性视神经病变有治疗作用；手术减压效果不肯定；外伤后无光感是视力预后不良的危险因索。【关键词】视神经疾病/药物疗法；视神经疾病/外科手术；视神经/损伤；肾上腺皮质激索类；预后中图分类号:R774.6R770.5文献标识码：

3、A文章编号：1005-1015(2000)02-0075-03Assessmentofsurgicalandhigh-dosecorticosteroidtreatmentintraumaticopticneuropathyMAZhizhong,LIUTiecheng,WEIShaopo,etal(DepartmentofOphthalmology,ChinesePLAGeneralHospital,Beijing100853,Chirrn)[Abstract】ObjectiveToevaluatethetreatmentofsurgeryandhigh-dosecorticosteroidr

4、elevantfactorstoprognosisintraumaticopticneuropathy.MethodsFortypatients(10eyes)withtraumaticopticneuropathywereenrolled.Opticnervedecompressionusingtranscranialapproaches,sinusendoscopyandorbital-ethmoidalsinusroutwereperformedin14patients.Elevcnpatientsweretreatedwithhigh-dosecorticosteroids(5case

5、swith1mg/kgdexamethasone,6caseswith30mg/kgmeth}4prednisolone)and15pdtientsreceivednonspecificmanagementchosebythemselves.Theoutcomesofvisualacuityinshorttermandfinalstagewerecomparedbetweensurgery,high-dosecorticosteroidandnonspecifietreatment.Multiplevariableanalysiswasdonetodeterminethefactorsaffe

6、ctingtheoutcomeofvisualacuity・ResultsNolightperceptionwerefoundin19cases(19outof44cases,47.5%),whereasvisualacuitywaslightperceptionto0・02in12cases(30.0%)and0.05orbetterin9cases(22.5%).Theoddsratioofhigh-dosecorticosteroidtononspecifictherapywas2.96(P^O.0125).Thefinalvisualacuityinpatientstreatedwit

7、hhigh-dosecorticosteroidwerebetterthanothertwogroups(P=0.005,P二0.023,respectively).Theshortterm(within3days)effectiveratewashigherincorticosteroidtherapygroupthanope灼tedgroup(P二0.024).Nolightperceptio