A型肉毒杆菌毒素不同注射位点在眼睑痉挛治疗中差异的对比研究  

Comparison of different botulinum A injection pattern in treatment of blepharospasm

作　　者：杨晖[1] 丁小虎[1] 赵秀娟[1] 尹小芳[1] 易长贤[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中国眼耳鼻喉科杂志》2013年第4期236-238,242,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的研究眼睑痉挛治疗中,A型肉毒杆菌毒素的眼轮匝肌不同注射模式对泪膜和早期疗效的影响。方法眼睑痉挛患者(20例)左右眼随机分入A组(全注射组)和B组(豁免下睑内侧组),A组20眼注射上睑内外侧、下睑内外侧、外眦部及眉头。B组20眼不注射下睑内侧部位点,其余注射位点同A组。观察注射前、注射后1周、注射后4周,患者眼睑痉挛主观症状评价量表、眼睑闭合不全高度、泪膜破裂时间、基础泪液分泌试验、前段相干光断层扫描测量泪河宽度。结果注射前、注射后1周和4周3个时间点,A组与B组患者眼睑痉挛Jankovic评价量表得分差异无统计学意义(P>0.05)。注射后1周部分患者出现眼睑闭合不全,但于注射后4周眼睑闭合程度显著减轻,与注射后1周相比差异有统计学意义(P<0.05),A组和B两组间差异无统计学意义(P>0.05)。泪膜破裂时间、基础泪液分泌试验2组间差异无统计学意义(P>0.05);前段OCT测量泪河宽度,注射后1周2组较注射前增大(P<0.05);注射后4周,和注射前相比差异无统计学意义;注射后1周:A组较B组泪河宽度增加,分别为(0.44±0.13)μm和(0.33±0.18)μm,差异有统计学意义(P<0.05)。结论在A型肉毒杆菌毒素注射治疗眼睑痉挛中,豁免下睑内侧的注射位点的模式于注射后早期对泪液引流的影响较少,对眼睑痉挛症状的早期控制两者无显著差异。Objective To study the influence of different injection locations′ influence on tear film in the treatment of blepharospasm with botulinum A. Methods Blepharospasm patients′ two eyes were randomly allocated into two groups： group A （full injection group, 20 eyes） and group B （ low lib inner injection waive group, 20 eyes）. Before injection, 1 week and 4 weeks after injection, Janknovic Rating Scale （JRS）, closure of eyelid, break-up time（BUT）, Schirmer I test and tearmeniscus height （TMH） were measured respectively. Results At all recording time points, no significant differences were found between group A and group B in JRS（P〉0.05）, BUT or Shimmer I test（P〉0.05）. TMH was significantly higher at 1 week after injection in both groups, but no significant difference was found in 4 weeks after injection compared with that before injection. One week after injection, TMH in group A [（0.44±0.13） μm] was significantly higher than group B [（0.33 ± 0.18）μm] （P〈0.05）. No significant differences of TMH were found at other recording time points（P〉0.05）. Conclusions In the treatment of blepharospasm with Botulinum A, low lib inner injection waive mode had less influence on tear drainage than the full injection mode, but no difference was found between the two modes in controlling the symptoms in the early stage after injection.

关 键 词：眼睑痉挛 肉毒杆菌毒素 注射位点 泪膜 

分 类 号：R746[医药卫生—神经病学与精神病学] R771.3[医药卫生—临床医学]