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目的:评估静脉注射甲基强的松龙(IVMP)对外伤性视神经病变患者的疗效。方法:回顾性分析2000-01至2007-06我院收治的16例外伤性视神经病变(TON)患者的临床资料。1g甲基强的松龙分3d静脉应用,然后口服泼尼松龙11d,并逐渐减量。记录从损伤开始到治疗开始的时间。视力变化是本研究结果的主要功能评价指标。在入院时,治疗后1,2,3d;1wk和1mo时,分别记录最佳矫正视力(BCVA)。结果:共有16例患者纳入本研究,平均年龄为30岁,其中男性14例、女性2例。引起TON的主要原因有摩托车事故(占69%),打架斗殴(占19%)和体育运动(占12%)。所有患者都表现有相对传入性瞳孔障碍。在损伤后4d内开始静脉注射甲基强的松龙,采用Snellen视力表检查视力,绝大部分(56%)患者视力提高超过3行或大于等于0.5(6/12)。在损伤后5d以上才开始用类固醇治疗,视力则没有任何进步。结论:治疗TON,静脉注射中等到大剂量甲基强的松龙仍将起到重要作用。静脉注射甲基强的松龙治疗TON可能存在伤后4d的关键时期,超过了这个时期,该治疗可能就毫无效果。但还需要有更多的研究来为我们提供有明显统计学意义的数据。
Objective: To evaluate the efficacy of intravenous methylprednisolone (IVMP) in patients with traumatic optic neuropathy. Methods: The clinical data of 16 patients with traumatic optic neuropathy (TON) admitted to our hospital from 2000-01 to 2007-06 were retrospectively analyzed. 1g methylprednisolone sub-3d vein application, and then oral prednisolone 11d, and gradually reduced. Record the time from the start of injury to the start of treatment. Visual acuity change is the main function evaluation index of this research result. At admission, 1, 2 and 3 days after treatment; best corrected visual acuity (BCVA) were recorded at 1 week and 1 month respectively. Results: A total of 16 patients were enrolled in this study, with an average age of 30 years, of whom 14 were males and 2 females. The main causes of TON are motorcycles (69%), fighting (19%) and sports (12%). All patients showed relatively affective pupil disorders. Intravenous methylprednisolone was administered within 4 days of injury and visual acuity was assessed using the Snellen Eye Chart. The majority of patients (56%) improved visual acuity by more than 3 lines or greater than 0.5 (6/12). 5d after injury began steroid treatment, visual acuity did not make any progress. CONCLUSIONS: Treatment of TON and intravenous injection of medium to high doses of methylprednisolone will continue to play an important role. Intravenous methylprednisolone treatment of TON may present a critical period of 4d after injury, beyond this period, the treatment may have no effect. But more research is needed to provide us with statistically significant data.