远达性外伤性视网膜病变的诊治体会

发布时间：2018-05-08 13:37

本文选题：远达性外伤性视网膜病变 + 扩血管药物　；参考：《中国医药指南》2014年01期

【摘要】：目的通过对本病的对照观察及诊治体会,能够引起临床医师对本病的重视,对本病的治疗提供一些新的经验和方法。方法对本院门、急诊和住院的60例患者进行回顾性分组对照分析,治疗首先应处理头颅、胸腹及四肢等处伤势,需要急诊手术的患者尽量及早手术治疗,纠正休克及水、电解质紊乱;及早查眼底,眼科治疗上可口服维生素C、B1、B6、rutin;后极部视网膜水肿明显的患者,必要时口服prednison(20 mg顿服,每日或隔日1次),以减少眼底视网膜血管渗漏;关键是扩血管药物(丹参或曲克芦丁等)静脉滴注的给药时机,其中治疗组30例是受伤36 h后给予扩血管药物,对照组30例是受伤后立即给予扩血管药物。结果 60例患者中43例预后较好,视力恢复或接近受伤前。其中治疗组25例,占治疗组83.3%;对照组18例,占对照组60%;17例预后欠佳,其中3例单或双眼患者形成永久性损害,矫正视力0.1;4例合并眼部外伤预后极差,视力为无光感。结论 83.3%的治疗组患者预后较好,眼底改变一般在1~2个月内逐渐恢复正常,出血及水肿渗出基本吸收,个别可遗留轻微的色素紊乱;若同时伴有其他眼外伤,可能形成视功能的永久性损害。本文作者认为在本病治疗中,扩血管药物的给药时机也相当重要,严重者将会影响预后,对照组伤后立即给予扩血管药物,18例预后较好,占对照组60%;而治疗组是受伤36 h后给予扩血管药物,结果 25例预后较好,占治疗组83.3%。因多数患者全身病情比较危重而忽视了本病的诊断及有效的治疗,应引起临床医师的足够重视。
[Abstract]:Objective to provide some new experience and methods for the treatment of this disease through the comparative observation, diagnosis and treatment of the disease. Methods A retrospective analysis of 60 patients in our hospital, emergency department and hospital was carried out. First of all, the injuries of head, chest, abdomen, limbs and so on should be treated. The patients who need emergency operation should be treated as early as possible to correct shock and water. Electrolyte disorder; early examination of the fundus, eye treatment can be oral vitamin C B1B1B6 rutin; patients with obvious retinal edema in the posterior pole, when necessary, oral administration of prednison(20 mg, daily or once every other day, to reduce retinal vascular leakage; The key point was the time of intravenous infusion of vasodilator (Danshen or troxerutin etc.) 30 cases in treatment group were given vasodilator after 36 h injury and 30 cases in control group were treated with vasodilator immediately after injury. Results 43 of 60 patients had better prognosis, visual acuity recovered or close to injury. There were 25 cases in the treatment group (83.3%), 18 cases in the control group and 6017 cases in the control group with poor prognosis, 3 cases with permanent damage in single or binocular patients, 4 cases with corrected visual acuity with poor prognosis of ocular trauma, and 4 cases with poor visual acuity without light sensation. Conclusion 83.3% of the patients in the treatment group have a good prognosis, the fundus changes gradually return to normal within 1 ~ 2 months, the bleeding and edema and exudation are absorbed basically, and some of the patients can have slight pigment disorder, if accompanied by other ocular trauma, May cause permanent damage to visual function. The authors believe that in the treatment of this disease, the time of administration of vasodilators is also very important, and the severe cases will affect the prognosis, while 18 cases in the control group will have a good prognosis immediately after injury. The treatment group was treated with vasodilator for 36 hours after injury. The results showed that the prognosis of 25 cases was better, accounting for 83.3% of the treatment group. The diagnosis and effective treatment of this disease have been neglected because of the critical condition of most patients, which should be paid enough attention by clinicians.
【作者单位】：锡盟医院眼科;
【分类号】：R779.1

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