影响外伤性视神经病变视力好转的临床因素分析  

Clinical effective factors on visual acuity in traumatic optic neuropathy

作　　者：戴艳丽[1,5] 王伟[2] 张译心[1] 魏世辉[1] 孙阔 周恩禄 

机构地区：[1]解放军总医院眼科,北京市100853 [2]中山大学中山眼科中心,眼科学国家重点实验室,广东省广州市510060 [3]沈阳军区65042部队卫生队,辽宁省沈阳市110001 [4]解放军95905部队卫生队,辽宁省锦州市121018 [5]沈阳军区政治部门诊

出　　处：《眼科新进展》2013年第3期243-247,共5页Recent Advances in Ophthalmology

基　　金：“十二五”国家科技支撑计划项目(编号:2012BAI08B06)~~

摘　　要：目的分析影响间接性外伤性视神经病变(indirect traumatic optic neuropathy,ITON)视力好转的临床因素。方法采用回顾性病例系列研究。对111例(118眼)ITON患者的临床资料进行回顾分析,通过单因素分析(χ2检验)和多因素分析(Logistic回归分析),筛选出影响ITON视力预后的危险因素。结果经过激素或激素联合手术治疗后,51眼(43.22%)视力得到提高。单因素分析显示:伤后有无光感、伤后距离治疗的时间(<2d:≥2d)、是否有手术治疗、有无眼眶骨折或血肿、有无蝶窦/筛窦积血、有无视神经管骨折、F-VEP改变(F-VEP异常:F-VEP正常,F-VEP熄灭:F-VEP正常)差异均有统计学意义(均为P<0.05)。多因素分析显示:伤后残留光感(OR=0.23)、伤后2d内接受糖皮质激素治疗(OR=0.13)是ITON患者视力改善的保护因素(P<0.05);而合并蝶/筛窦积血(OR=9.57)、合并视神经管骨折(OR=4.09)、F-VEP异常(OR=3.73)或熄灭(OR=20.48)是ITON患者视力无提高的危险因素。结论 ITON视力预后与多种临床因素有关,明确影响视力预后的危险因素和保护因素,有利于临床医师制定合理的临床策略,指导治疗。Objective To investigate the clinical effective factors on visual acuity recovery in patients with indirect traumatic optic neuropathy （ITON）. Methods A retrospective study was conducted to analyze the clinical characteristics and prognoses of 111 patients （118 eyes） with ITON. The X2 test and multiple logistic regression analy- ses were used to evaluate potential prognostic factors on visual acuity. Results Fifty- one eyes （43.22%） have been experienced visual improvement after aggressive treat- ment. Univariate logistic regression analyses showed that there were statistical differ- ences in having light perception, surgical treatment and hematocele in sphenoidal sinus and/or ethmoid sinuses or not, time from treatment after traumatic （ less than 2 days or more than 2 days） and F-VEP changes （ all P 〈 0.05 ）. Multiple logistic regression analy- ses identified that initial BCVA with light perception or better vision （ OR = 0. 23 ） and treating within 2 days after injury（ OR =0.13） were the protective factors on visual acu- ity recovery, hemorrhage within the ethmoid and/or sphenoid sinus （ OR = 9.57 ）, the presence of optic canal fracture （ OR = 4.09 ）, with abnormal VEP （ OR = 3.73 ） or VEP showed no wave（ OR = 20.48 ） were the risk factors on visual acuity recovery. Conclu- sion The visual acuity recovery in patients with ITON is related with many clinical factors, it should be identified as protective and risk factors, which are benefit to mak- ing the clinical strategy and directing the treatment for clinical physician.

关 键 词：外伤性视神经病变 预后 影响因素 

分 类 号：R774.6[医药卫生—眼科]