眶内电针治疗后交通动脉瘤致动眼神经麻痹术后的疗效及相关因素分析  

Efficacy of intraorbital electroacupuncture for posterior communicating artery aneurysms complicated with oculomotor nerve palsy after surgery and its influencing factors

作　　者：刘畅[1] 徐善才[1] 栗雪梅 刘铁镌[1] 周凌云[1] LIU Chang;XU Shancai;LI Xuemei;LIU Tiejuan;ZHOU Lingyun(The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《中国实用神经疾病杂志》2023年第3期291-298,共8页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:82074524)。

摘　　要：目的分析眶内电针治疗后交通动脉瘤致动眼神经麻痹术后的疗效以及影响疗效的相关因素。方法回顾性分析哈尔滨医科大学附属第一医院2014-01—2021-07后交通动脉瘤致动眼神经麻痹术后患者的临床资料,将经过眶内电针治疗的患者定为电针组,未电针治疗的患者定为对照组。所有患者术后随访12个月以上,比较电针组与对照组6个月、12个月时的动眼神经麻痹恢复情况。电针组以痊愈为结局指标,比较痊愈组与未痊愈组患者的性别、年龄、高血压、糖尿病、术前动眼神经麻痹程度、动脉瘤大小、动脉瘤侧边、是否动脉瘤破裂蛛网膜下腔出血、Hunt-Hess分级、手术方式、手术时机(发病至手术的时间)、眼运动神经麻痹评分、针灸时机(手术至开始针灸治疗的时间)、治疗次数等可能影响疗效的因素进行统计学分析。结果共纳入研究的患者68例,其中电针组24例,未电针组共44例。12个月后电针组痊愈11例(11/24,45.83%),总恢复率95.83%,未电针组痊愈14例(14/44,31.82%),总恢复率68.18%。2组在6个月、12个月时恢复情况上差异均有统计学意义(P均<0.05)。电针组患者眼运动神经麻痹各项评分均明显减小,差异有统计学意义(P均<0.01);其中眼睑运动、水平内收、下视运动较上视运动、瞳孔散大及光反射改善明显。电针组痊愈与未痊愈组间比较结果显示,在动脉瘤大小(P=0.047)、手术时机(P=0.047)、眼运动神经麻痹评分(P=0.004)等方面2组患者存在差异。多因素分析结果表明眼运动神经麻痹评分为影响疗效的危险因素(OR=2.016,P=0.042)。结论眶内电针可有效治疗后交通动脉瘤致动眼神经麻痹术后患者的复视、眼球运动障碍症状,其治疗疗效受眼运动神经麻痹评分影响,其评分高痊愈的可能性低。Objective To analyze the effectiveness and related factors of intraorbital electroacupuncture(IEA)in the treatment of posterior communicating artery aneurysms complicated with oculomotor nerve palsy after surgery.Methods We summarized the clinical data of patients from January 2014 to July 2021 who suffered ocu⁃lomotor nerve palsy following posterior communicating artery aneurysms after surgery.All patients were followed up for more than 12 months after operation,and the recovery of oculomotor nerve palsy was compared between the IEA group and the control group(without IEA treatment)at 6 and 12 months.Complete recovery was set as the outcome indicator.Factors such as gender,age,hypertension,diabetes mellitus,degree of oculomotor nerve palsy,aneurysm size,aneurysm side,SAH or not,Hunt-Hess grade,operation method,operation timing,oculomotor nerve palsy score,acupuncture timing,number of treatments were analyzed and compared between the recovered patients and non-recovered patients.Results A total of 68 patients were enrolled,including 24 in the IEA group and 44 in the control group.In the electroacupuncture group,11 cases(45.83%)recovered,with the overall effectiveness of 95.83%,while in the control group,14 cases(31.82%)recovered,with the overall effectiveness of 68.18%.There was a statistically significant difference between the two groups in terms of recovery at 6 months and 12 months(all P<0.05).The patients had significantly reduced scores for each item in oculomotor nerve palsy after treatment(all P<0.01).Particularly,ptosis,horizontal adduction and eyeball downward movement were signifi⁃cantly improved compared with eyeball upward movement,pupil dilation,and light reflex.Compared to non-recovered patients,recovered patients aneurysm size,operation timing,oculomotor nerve palsy score,;these results were statistically significant(all P<0.05).Multivariate logistic regression analysis showed oculomotor nerve palsy score were risk factors of treatment effectiveness(OR=2.016,P=0.042).Conclusion IEA is an effec

关 键 词：后交通动脉瘤 动眼神经麻痹 康复 复视 电针 

分 类 号：R774.6[医药卫生—眼科]