高压氧综合治疗对非动脉炎性前部缺血性视神经病变患者的临床疗效

目的探讨高压氧综合治疗非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)患者的临床疗效。方法选取2017年1月至2019年1月郑州市第二人民医院收治的NAION患者110例,采用随机数字表法将患者分为对照组(55例)和高压氧组(55例)。对照组给予激素冲击、改善微循环、营养神经等常规治疗;高压氧组在对照组基础上给予高压氧治疗,舱压0.2 MPa(2.0 ATA),每日1次,10次为1个疗程,共治疗30 d。观察并分析2组患者治疗前后的视力、视野平均敏感度(mean sensitivity, MS)、视野平均缺损(mean defect, MD)、图形视觉诱发电位(pattern visual evoked potential, PVEP)振幅、潜伏期,评定治疗有效率。观察高压氧综合治疗对NAION患者血清人软骨糖蛋白-39 (又称几丁质酶-3样蛋白-1,chtinase-3-like-1 protein, YKL-40)的影响。结果 2组患者治疗前的视力、视野MS、视野MD、PVEP振幅、潜伏期比较,差异均无统计学意义(P>0.05)。高压氧组治疗后视野MD低于对照组及本组治疗前,视力和视野MS高于对照组及本组治疗前,差异均有统计学意义(P<0.05)。高压氧组患者的PVEP振幅高于本组治疗前及对照组,潜伏期短于本组治疗前及对照组,差异均有统计学意义(P<0.05)。治疗7 d时2组血清YKL-40达到峰值,高压氧组治疗3、7、15、30 d时均低于同时间点对照组,差异均有统计学意义(P<0.05)。高压氧组患者的总有效率(83.63%)高于对照组(74.55%),组间差异无统计学意义(P>0.05)。结论高压氧综合治疗可以明显提高NAION患者的视力、视野MS,改善患者视野MD、PVEP振幅、潜伏期,减轻炎性反应,有利于提高临床疗效。

Clinical effect of hyperbaric oxygen combined therapy on patients with non-arteritic anterior ischemic optic neuropathy

Objective To observe and evaluate the clinical effect of hyperbaric oxygen combined therapy on patients with non-arteritic anterior ischemic optic neuropathy(NAION).Methods A total of 110 patients with NAION admitted to the Department of Ophthalmology of Zhengzhou Second Hospital from January 2017 to January 2019 who met the inclusion criteria were selected and divided into control group(55 cases)and hyperbaric oxygen group(55 cases)by random number table method.The control group was given conventional therapies such as hormone shock,microcirculation improvement,and nerve nutrition,while the hyperbaric oxygen group was given conventional treatment and hyperbaric oxygen therapy,with chamber pressure of 2.0 ATA,once a day,10 times for a course of treatment for 30 days.The visual acuity,mean sensitivity(MS),mean defect(MD),pattern visual evoked potential(PVEP)amplitude,and latency period of the two groups were observed and analyzed to evaluate the efficacy of treatment.The effect of hyperbaric oxygen combined therapy on serum human chondroglycoprotein-39(chtinase-3-like-1 protein,YKL-40)in patients with NAION was also observed.Results Before treatment,there were no statistically significant differences in visual acuity,mean sensitivity,mean defect,PVEP amplitude,latency period,and serum YKL-40 between the two groups(P>0.05).The visual MD in the hyperbaric oxygen group after treatment was lower than that in the control group after treatment and also lower than that before treatment in the same group,and the differences were statistically significant(P<0.05).The visual acuity and MS in the hyperbaric oxygen group after treatment were higher than those in the control group and also those before treatment in the same group,and the differences were statistically significant(P<0.05).The PVEP amplitudes of the patients in the hyperbaric oxygen group were higher than those in the control group and also those before treatment in the same group,and the latency period was earlier than that in the control group and also that before treatment in the same group,with statistically significant differences(P<0.05).The level of serum YKL-40 reached the peak after 7 days of treatment.After 3,7,15 and 30 days of treatment,the levels of serum YKL-40 were all lower than those of the control group on the same day,with statistically significant differences(P<0.05).After treatment,the total effective rate of the hyperbaric oxygen group(83.63%)was higher than that of the control group(74.55%),but there was no statistically significant difference(P>0.05).Conclusion Hyperbaric oxygen combined therapy can significantly improve the vision acuity,MS,MD,PVEP amplitude,and latency period of the patients with NAION,and reduce inflammatory response,which is beneficial to improve clinical efficacy.