眼部症状首诊的颈动脉狭窄患者19例临床分析  

Clinical analysis of 19 patients with carotid artery stenosis first diagnosed with ocular symptoms

作　　者：唐瑜[1] 白晶[1] TANG Yu;BAI Jing(Department of Ophthalmology,Dalian Municipal Central Hospital,Liaoning Province,Dalian116033,China)

机构地区：[1]大连市中心医院眼科,辽宁大连116033

出　　处：《中国当代医药》2021年第8期112-114,118,共4页China Modern Medicine

基　　金：辽宁省大连市医学科学研究计划项目(1711023)。

摘　　要：目的分析眼部症状首诊的颈动脉狭窄患者眼科诊断及治疗结果,旨在减少颈动脉狭窄的漏诊,改善患者预后,提高患者生存质量。方法回顾性选取2018年1月~2020年11月因眼部症状就诊于大连市中心医院眼科,后确诊为颈动脉狭窄的患者19例(19眼)。所有患者行眼科常规检查、眼底荧光造影检查及颈动脉、球后血管彩色超声多普勒检查,分析患者的眼科检查情况、颈动脉狭窄分级、治疗及预后情况。结果就诊主诉突发单眼视力下降15例,一过性黑朦2例,视物不见伴眼胀痛2例。眼科检查情况,视网膜静脉阻塞10例,视网膜动脉阻塞2例,眼缺血综合征3例(其中2例合并新生血管性青光眼),前部缺血性视神经病变2例,一过性黑朦无眼科具体诊断2例。颈动脉狭窄分级,颈动脉狭窄30%~50%者2例,51%~70%者9例,71%~99%者8例。眼科均予改善微循环、扩血管等对症治疗。颈动脉狭窄程度未达外科干预标准者口服药物,达外科干预标准经外科干预后,视力预后改善不明显,但荧光素血管造影术检查法显示臂-视网膜循环时间均有所改善。结论颈动脉狭窄患者可因眼部症状首诊于眼科,应予高度重视,及时筛查,避免漏诊,减少全身并发症,提高患者生存质量。Objective To analyze the ophthalmological diagnosis and treatment results of carotid artery stenosis patients first diagnosed with ocular symptoms,in order to reduce the missed diagnosis of carotid artery stenosis,improve the prognosis of patients,and improve the quality of life of patients.Methods A total of 19 patients(19 eyes)who were admitted to the Ophthalmology Department of Dalian Municipal Central Hospital from January 2018 to November 2020 due to ocular symptoms and were later diagnosed with carotid artery stenosis were retrospectively selected.All patients underwent routine ophthalmological examination,fundus fluorescent-contrast examination,and color ultrasonography of carotid artery and retrobulbular vessels.The ophthalmological examination,carotid artery stenosis grading,treatment and prognosis of the patients were analyzed.Results There were 15 cases of sudden decline of monocular vision,2 cases of transient amaurosis,2 cases of vision loss with eye pain.There were 10 cases of retinal vein occlusion,2 cases of retinal artery occlusion,3 cases of ocular ischemic syndrome(including 2 cases with neovascular glaucoma),2 cases of anterior ischemic optic neuropathy,and 2 cases of transient amaurosis without specific ophthalmic diagnosis.Carotid artery stenosis classification,carotid stenosis was 30%-50%in 2 cases,51%-70%in 9 cases and 71%-99%in 8 cases.In ophthalmology department,symptomatic treatments such as improving microcirculation and vasodilating were given.Patients with carotid artery stenosis that did not meet the surgical intervention criteria were given oral drugs.After surgical intervention,the visual prognosis was not significantly improved,but fluorescene angiography showed that the arm-retinal circulation time was improved.Conclusion Patients with carotid artery stenosis can be first diagnosed in ophthalmology due to ocular symptoms.Therefore,great attention should be paid to timely screening to avoid missed diagnosis,reduce systemic complications and improve the quality of life of patients

关 键 词：颈动脉狭窄 眼缺血综合征 新生血管性青光眼 视网膜动脉阻塞 视网膜静脉阻塞 

分 类 号：R771.3[医药卫生—眼科]