颈动脉重度狭窄眼部表现的临床观察  

Clinical observation of the ocular manifestations in the patients with severe carotid artery stenosis

作　　者：冯雪艳[1] 刘逾[1] 曹婷婷[1] 范玉香[1] 

机构地区：[1]沧州市中心医院眼一科,河北省沧州市206100

出　　处：《实用老年医学》2015年第6期473-475,共3页Practical Geriatrics

摘　　要：目的探讨颈动脉重度狭窄患者的眼部表现及其发生机制。方法选择2012年2月至2014年3月沧州市中心医院神经内科收治的颈动脉重度狭窄患者62例,其中单侧重度狭窄59例,双侧重度狭窄3例,行眼部常规检查,明确眼部缺血的症状及体征。对59例单侧颈动脉重度狭窄患者行双眼球后血管彩超,检测其眼动脉的收缩期峰值流速(PSV)、舒张末期流速(EDV)。结果 62例颈动脉重度狭窄患者57例有眼缺血表现,其中表现为一过性黑矇44例(77.2%),虹膜新生血管5例(8.7%),新生血管性青光眼3例(5.3%),视网膜动脉阻塞3例(5.3%),不同程度不同部位的视网膜渗出、血管变细、点片状出血及微血管瘤21例(36.8%)。59例单侧颈动脉重度狭窄患者重度狭窄侧眼动脉PSV[(24.39±2.56)cm/s]较对侧降低,差异有统计学意义(P<0.05),EDV[(8.76±1.26)cm/s]较对侧降低,差异有统计学意义(P<0.05)。颈动脉重度狭窄侧发现眼动脉反流16例,对侧眼3例。结论眼部缺血症状是颈动脉重度狭窄的重要临床表现之一,颈动脉重度狭窄会引起明显眼部血流动力学变化。Objective To observe the ocular manifestations in the patients with severe carotid artery stenosis and to investigate the pathogenesis. Methods Sixty-two patients with severe carotid artery stenosis were enrolled from February2012 to March 2014,including 59 cases of unilateral severe carotid artery stenosis,and 3 cases of bilateral disorder. All patients were detected by regular eye test in order to find out the manifestations of ocular ischemia. The ophthalmic artery of 59 patients with unilateral severe carotid artery stenosis were examinated by color doppler ultrasound,to detect vascular peak systolic velocity（ PSV）,end diastolic velocity（ EDV）. Results There were 57 patients with ocular ischemia diseases,including amaurosis fugax（ 44 patients,77%）,rubeosis iridis（ 5 patients,9%）,neovascular glaucoma（ 3 patients,5%）,retinal artery occlusion（ 3 patients,5%）,different degree retinal hemorrhage and exudation（ 21 patients,37%）. PSV[（ 24. 39 ± 2. 56）cm / s],EDV[（ 8. 76 ± 1. 26） cm / s]of the ophthalmic artery in 59 patients with unilateral severe carotid artery stenosis were lower than those of the contralateral [PSV（ 28. 53 ± 3. 61） cm / s,EDV（ 11. 27 ± 2. 03） cm / s]. The differences was significant（ P〈0. 05）. Sixteen patients showed reversed ophthalmic artery flow in the severe carotid artery stenosis side,and 3 patients in the contralateral side. Conclusions Ocular ischemia is one of the important clinical manifestations of severe carotid artery stenosis. Severe carotid artery stenosis could lead to retrobulbar vascular hemodynamic changes.

关 键 词：颈动脉狭窄 眼动脉 眼部缺血 

分 类 号：R543.4[医药卫生—心血管疾病]