CAJ | 학술논문

目的观察增强型体外反搏(EECP)辅助药物治疗非动脉炎性前部缺血性视神经病变(NAION)的临床效果和安全性.方法回顾性病例对照研究.临床确诊为NAION的48例患者48只眼纳入研究.其中,有出血性疾病、严重的主动脉瓣关闭不全、主动脉瘤及夹层动脉瘤、肢体有血栓性静脉炎或感染病灶及不能控制的严重高血压等EECP治疗禁忌的32例32只眼行单纯扩张血管及营养神经药物治疗(药物治疗组)；无EECP治疗禁忌的16例16只眼在扩张血管及营养神经药物治疗的基础上,同时行EECP治疗(EECP治疗组).两组患者性别(x2=0.000)、年龄(t=1.096)、病程(t=1.613)及视力(x2=0.000)比较,差异无统计学意义(P＞0.05).EECP1次/d,1 h/次,每周治疗5d.EECP治疗组患者中,行12次治疗者14例,行36次治疗者2例.观察EECP治疗组患者治疗期间全身及眼部副作用的发生情况.治疗后所有患者行矫正视力检查,对比分析EECP治疗6、12次时,药物治疗组与EECP治疗组患者视力恢复程度的差异以及所有患者视力恢复程度与病程、治疗前视力的相关性.其中,以矫正视力较治疗前提高≥3级为显效,视力较治疗前提高≤2级为有效,视力较治疗前无进步甚至下降为无效.结果 EECP治疗6次时,EECP治疗组16只患眼中,视力显效2只眼,有效5只眼,无效9只眼；药物治疗组32只患眼中,视力显效3只眼,有效8只眼,无效21只眼.两组视力恢复程度比较,差异无统计学意义(x2=0.404,P＞0.05).EECP治疗12次时,EECP治疗组16只患眼中,视力显效6只眼,有效9只眼,无效1只眼；药物治疗组32只患眼中,视力显效4只眼,有效10只眼,无效18只眼.两组视力恢复程度比较,差异有统计学意义(x2=11.621,P＜0.05).所有患者视力恢复程度与病程呈负相关(r=-0.860,P＜0.05),与治疗前视力呈正相关(r=1.380,P＜0.05).EECP治疗组患者在治疗期间均未发生皮肤擦伤、血肿、新的视网膜出血等副作用.结论多次EECP辅助药物治疗较单纯药物治疗更有助于提高NAION患者视力恢复.但需要一定次数的重复治疗；未见局部及全身副作用. 目的觀察增彊型體外反搏(EECP)輔助藥物治療非動脈炎性前部缺血性視神經病變(NAION)的臨床效果和安全性.方法迴顧性病例對照研究.臨床確診為NAION的48例患者48隻眼納入研究.其中,有齣血性疾病、嚴重的主動脈瓣關閉不全、主動脈瘤及夾層動脈瘤、肢體有血栓性靜脈炎或感染病竈及不能控製的嚴重高血壓等EECP治療禁忌的32例32隻眼行單純擴張血管及營養神經藥物治療(藥物治療組)；無EECP治療禁忌的16例16隻眼在擴張血管及營養神經藥物治療的基礎上,同時行EECP治療(EECP治療組).兩組患者性彆(x2=0.000)、年齡(t=1.096)、病程(t=1.613)及視力(x2=0.000)比較,差異無統計學意義(P＞0.05).EECP1次/d,1 h/次,每週治療5d.EECP治療組患者中,行12次治療者14例,行36次治療者2例.觀察EECP治療組患者治療期間全身及眼部副作用的髮生情況.治療後所有患者行矯正視力檢查,對比分析EECP治療6、12次時,藥物治療組與EECP治療組患者視力恢複程度的差異以及所有患者視力恢複程度與病程、治療前視力的相關性.其中,以矯正視力較治療前提高≥3級為顯效,視力較治療前提高≤2級為有效,視力較治療前無進步甚至下降為無效.結果 EECP治療6次時,EECP治療組16隻患眼中,視力顯效2隻眼,有效5隻眼,無效9隻眼；藥物治療組32隻患眼中,視力顯效3隻眼,有效8隻眼,無效21隻眼.兩組視力恢複程度比較,差異無統計學意義(x2=0.404,P＞0.05).EECP治療12次時,EECP治療組16隻患眼中,視力顯效6隻眼,有效9隻眼,無效1隻眼；藥物治療組32隻患眼中,視力顯效4隻眼,有效10隻眼,無效18隻眼.兩組視力恢複程度比較,差異有統計學意義(x2=11.621,P＜0.05).所有患者視力恢複程度與病程呈負相關(r=-0.860,P＜0.05),與治療前視力呈正相關(r=1.380,P＜0.05).EECP治療組患者在治療期間均未髮生皮膚抆傷、血腫、新的視網膜齣血等副作用.結論多次EECP輔助藥物治療較單純藥物治療更有助于提高NAION患者視力恢複.但需要一定次數的重複治療；未見跼部及全身副作用.
목적 관찰증강형체외반박(EECP)보조약물치료비동맥염성전부결혈성시신경병변(NAION)적림상효과화안전성.방법 회고성병례대조연구.림상학진위NAION적48례환자48지안납입연구.기중,유출혈성질병、엄중적주동맥판관폐불전、주동맥류급협층동맥류、지체유혈전성정맥염혹감염병조급불능공제적엄중고혈압등EECP치료금기적32례32지안행단순확장혈관급영양신경약물치료(약물치료조)；무EECP치료금기적16례16지안재확장혈관급영양신경약물치료적기출상,동시행EECP치료(EECP치료조).량조환자성별(x2=0.000)、년령(t=1.096)、병정(t=1.613)급시력(x2=0.000)비교,차이무통계학의의(P＞0.05).EECP1차/d,1 h/차,매주치료5d.EECP치료조환자중,행12차치료자14례,행36차치료자2례.관찰EECP치료조환자치료기간전신급안부부작용적발생정황.치료후소유환자행교정시력검사,대비분석EECP치료6、12차시,약물치료조여EECP치료조환자시력회복정도적차이이급소유환자시력회복정도여병정、치료전시력적상관성.기중,이교정시력교치료전제고≥3급위현효,시력교치료전제고≤2급위유효,시력교치료전무진보심지하강위무효.결과 EECP치료6차시,EECP치료조16지환안중,시력현효2지안,유효5지안,무효9지안；약물치료조32지환안중,시력현효3지안,유효8지안,무효21지안.량조시력회복정도비교,차이무통계학의의(x2=0.404,P＞0.05).EECP치료12차시,EECP치료조16지환안중,시력현효6지안,유효9지안,무효1지안；약물치료조32지환안중,시력현효4지안,유효10지안,무효18지안.량조시력회복정도비교,차이유통계학의의(x2=11.621,P＜0.05).소유환자시력회복정도여병정정부상관(r=-0.860,P＜0.05),여치료전시력정정상관(r=1.380,P＜0.05).EECP치료조환자재치료기간균미발생피부찰상、혈종、신적시망막출혈등부작용.결론 다차EECP보조약물치료교단순약물치료경유조우제고NAION환자시력회복.단수요일정차수적중복치료；미견국부급전신부작용.
Objective To observe the efficiency and security of enhanced external counter pulsation (EECP) as an adjunctive therapy for nonarteritic anterior ischemic optic neuropathy (NAION).Methods This was a retrospective case-control study.Forty-eight patients (48 eyes) with NAION were enrolled in this study.Thirty-two patients (32 eyes) who had been treated with blood vessel dilation and nerve nutrition drugs comprised the medicated group.Sixteen of the patients (16 eyes) in the medicated group were treated with EECP combined with blood vessel dilating and nerve nutrition drugs as EECP group.The differences were not statistically significant between groups in gender(x2 =0.000),age (t=1.096),course (t=1.613) and visual acuity (x2=0.000,P＞0.05).EECP was done once a day,one hour per time,five times a week.Fourteen eyes were treated 12 times EECP and two eyes were treated 36 times EECP within the EECP group.Systemic and ocular side effects were observed during EECP treatment.Corrected visual acuity was examined after treatment and the differences of visual acuity between medicated group and EECP group treated six times and or 12 times with EECP treatment were analyzed.The correlation of visual acuity level,and course,and acuity before treatment were analyzed.A significant improvement in visual acuity was defined as a sustained improvement of three or more visual acuity gradations.An effective of treatment was defined as a sustained improvement of two or less visual acuity gradations.No effective of treatment was defined as visual acuity dropped or showed no progress.Results After six treatments of EECP,within the 16 eyes of EECP group,two eyes achieved significant improvement,five eyes had effective improvement,and nine eyes did not show any improvement.Within the 32 eyes of medicated group,three eyes achieved significant improvement,eight eyes had effective improvement,and 21 eyes did not show any improvement.There was no statistically significant difference in vision between the two groups (x2 =0.404,P＞ 0.05).After 12 treatments of EECP,within the 16 eyes of EECP group,six eyes achieved significant improvement,nine eyes had effective improvement,and one eye did not show any improvement.Within the 32 eyes of medicated group,four eyes achieved significant improvement,10 eyes had effective improvement,and 28 eyes did not show any improvement.The difference was statistically significant comparing the vision level between the two groups (x2 =11.621,P＜0.05).The curative effect of patients negatively correlated with course of the disease (r =-0.860,P＜ 0.05),but positively correlated with visual acuity before treatment (r=1.380,P＜0.05).Skin bruises,hematoma,new retinal bleeding and other side effects did not occur in patients during EECP treatment.Conclusions Many-time therapy of EECP can improve vision of NAION patients.There is no local and general complications after a certain number of therapy.