全膝关节置换后的多模式镇痛

背景：围全膝关节置换期疼痛处理一直是临床所关注的重点问题,寻找安全有效的镇痛方式,成为关节外科医生的重要任务之一。 目的：比较硬膜外镇痛和股神经阻滞镇痛在患者全膝关节置换后镇痛、康复的效果,探索相关的多模式联合镇痛方案。 方法：随机选取行单侧膝关节置换的患者40例,按照镇痛方案的不同分为硬膜外镇痛组和股神经阻滞镇痛组,每组20例。患者在连续硬膜外麻醉下进行单侧膝关节置换并进行术前宣教和塞来昔布给药。置换后硬膜外镇痛组通过留置导管连接0.2%罗哌卡因、2 mg/L芬太尼止痛泵镇痛;股神经阻滞镇痛组通过股神经阻滞导管间断注射0.2%罗哌卡因镇痛。观察全膝关节置换后患者6,12,24 h和2-7 d每天的疼痛程度,以及2-7 d每天的膝关节活动度。 结果与结论：全膝关节置换后2-7 d,2组患者每天的静息痛和活动痛的目测类比评分均呈下降的趋势,股神经阻滞镇痛组患者的疼痛程度小于硬膜外镇痛组患者。置换后2-7 d,股神经阻滞镇痛组和硬膜外镇痛组患者膝关节活动度都逐渐升高,股神经阻滞镇痛组患者膝关节活动度大于硬膜外镇痛组。结果说明虽然硬膜外镇痛和股神经阻滞镇痛都能缓解全膝关节置换术后疼痛,但股神经阻滞镇痛在全膝关节置换后近期的运动镇痛效果优于硬膜外镇痛,能加快患者关节功能的康复,且多模式联合镇痛方案能有效控制疼痛。     

关节周围局部注射镇痛药对全膝关节置换后镇痛的Meta分析

背景：传统全膝关节置换的镇痛方式较多,但这些方法常常带来一些不良事件。 目的：应用循证医学Meta分析评价全膝关节置换过程中关节周围局部注射镇痛药后镇痛效果的安全性及有效性。 方法：通过计算机检索PubMed、Cochrane Library、EMBASE、CNKI、CBM、WANGFANG有关全膝关节置换镇痛的文献,检索年限均为2000-01-01/2011-04-30。纳入所有全膝关节置换镇痛的随机对照试验,两组其他处理措施相同,试验组在对照组的基础上术中关节周围局部注入混合镇痛药。由2名评价者独立进行筛选及资料提取,采用RevMan5.1.2软件对符合质量标准的研究进行Meta分析。 结果与结论：最后共纳入10个研究,合计694例受试患者。进行Meta分析结果显示,与全膝关节置换传统镇痛方式相比,试验组置换后目测类比活动评分较低[WMD=-1.04,95%CI(-1.26,-0.82),P < 0.000 01]、置换后目测类比静止评分较低[WMD=-0.67,95%CI(-0.81,-0.54),P < 0.000 01]、置换后再镇痛例数少[RR=0.26,95%CI(0.17,0.40),P < 0.000 01]、置换后再镇痛吗啡需要量少[WMD=-6.89,95%CI(-8.91,-4.86),P < 0.000 01],两组不良事件发生率相差不大[RR=0.62,95%CI(0.21,1.84),P=0.39]。当前证据表明,全膝关节置换过程中关节周围局部注射镇痛药是一种有效、安全可靠的镇痛方式,但是疗效和安全性仍需大样本的随机对照试验来验证。     

全膝关节置换后持续股神经阻滞与持续硬膜外镇痛的Meta分析

背景：疼痛是全膝关节置换后阻碍患者早期恢复的重要原因,持续硬膜外镇痛和持续股神经阻滞均是全膝关节置换后镇痛的有效方法,但哪种方法镇痛效果更好且并发症较少一直存在争议。 目的：比较全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的临床疗效及安全性。 方法：计算机检索Cochrane-Library、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang等数据库,同时检索学位论文、会议论文等,检索时间为各数据库建库至2014-10-01,纳入全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的随机对照试验。采用Cochrane系统评价的方法进行评价,用RevMan 5.0软件进行统计学分析。 结果与结论：共纳入12篇随机对照试验,4篇英文,8篇中文,共680例患者,其中持续股神经阻滞组患者343例,持续硬膜外镇痛组患者337例。Meta分析结果显示,持续股神经阻滞组与持续硬膜外镇痛组在全膝关节置换后6,12,24,48 h的目测类比评分差异均无显著性意义;但与持续硬膜外镇痛组相比,持续股神经阻滞可减少恶心/呕吐(RR=0.36,95%CI：0.21-0.63,P=0.003)、尿潴留(RR=0.08,95%CI：0.04-0.16, P < 0.001)和头晕(RR=0.24,95%CI：0.06-0.99,P=0.05)的发生率。提示与硬膜外镇痛相比,全膝关节置换后持续股神经阻滞镇痛同样可以提供良好的镇痛效果,有利于患者早期功能恢复训练,且不良反应少,是一种安全、有效的镇痛方法。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

不同镇痛方式对全膝关节置换后关节功能及不良反应的影响

背景：全膝关节置换后剧烈疼痛是导致患者置换后膝关节功能恢复不佳的重要因素,如何给予患者置换后效果满意的镇痛方案是目前研究的热点。 目的：观察不同镇痛方案对全膝关节置换患者置换后疼痛和功能恢复的影响。 方法：将徐州市中心医院自2010年3月到2014年2月期间收治的60例单侧的膝关节置换患者随机分为3组：硬膜外镇痛组,静脉镇痛组,连续股神经阻滞镇痛组,每组各20例,均采用相应方法进行术后镇痛。记录并比较3组患者置换前、置换后不同状态下1,6,24,48,96 h的目测类比评分,置换后24,48,72 h关节活动度恢复情况;膝关节置换患者膝关节KSS评分;置换后出现的不良反应。 结果与结论：与置换前比较,置换后1,24,48,96 h连续股神经阻滞镇痛组患者目测类比评分降低(P < 0.05)。连续股神经阻滞镇痛组患者关节活动度恢复最好,其次为硬膜外镇痛组患者,静脉镇痛组恢复最差(P < 0.05);同置换前比较,3组患者置换后1,3个月膝关节功能KSS评分均升高(P < 0.05)。同连续股神经阻滞镇痛组患者比较,置换后1,3个月硬膜外镇痛组,静脉镇痛组患者膝关节功能评分降低(P < 0.05)。结果证实,连续股神经阻滞镇痛方案置换后总体效果较好,能够帮助患者更好的进行置换后关节功能恢复,安全可靠。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

膝关节置换后注射含类固醇鸡尾酒治疗安全性的荟萃分析

背景:类固醇具有强大的抗炎、止吐及镇痛作用而被广泛用于围术期镇痛,有研究表明膝关节置换后膝关节周围注射含类固醇的鸡尾酒镇痛疗法可缓解术后疼痛、改善膝关节活动度及减少相关并发症,但也有研究认为类固醇可增加术后感染、髌腱断裂等风险。因此膝关节周围注射含类固醇鸡尾酒疗法在膝关节置换后镇痛中的安全性和疗效尚存在争议。目的:通过荟萃分析系统评价膝关节置换后运用含类固醇鸡尾酒疗法镇痛的疗效和安全性。方法:检索PubMed/Medline、Cochrane Central Register of Controlled Trials、EMBASE数据库2019年4月前的文献,收集所有膝关节置换后局部运用类固醇镇痛的随机对照试验,筛选出符合条件的文献。由2名研究者分别单独使用Cochrane 5.0风险偏倚评估工具对文献方法学偏倚进行评价,提取文献数据并用Review Manager 5.2软件进行荟萃分析。结果与结论:①共纳入10篇随机对照试验,820例患者;②Meta分析显示:类固醇组术后第1天的目测类比评分低于对照组[MD=-1.52,95%CI(-2.94,-0.10),P=0.04],术后第1,2,3,4,5天的关节活动度高于对照组[MD=11.57,95%CI(9.85,13.30),P<0.000 01;MD=9.03,95%CI(6.67,11.38),P<0.000 01:MD=5.73,95%CI(0.85,10.60),P=0.02:MD=5.53,95%CI(0.68.10.38),P=0.03;MD=5.90.95%CI(0.87.10.93),P=0.02],吗啡使用量少于对照组[MD=-7.94,95%CI(-14.35,-1.53),P=0.02],住院时间短于对照组[MD=-0.98,95%CI(-1.25,-0.71),P<0.000 01],直腿抬高所需时间短于对照组[MD=0.65,95%CI(-0.86,0.44),P<0.000 01],术后C-反应蛋白水平低于对照组[WMD=-4.82,95%CI(7.41,2.23),P=0.000 3];两组膝关节KSS评分、并发症发生率比较差异无显著意义;③结果表明,膝关节置换后关节周围运用含类固醇的鸡尾酒疗法安全有效。     

连续股神经阻滞与静脉自控对全膝关节置换的镇痛效果比较

背景：近年来连续股神经阻滞在人工全膝关节置换过程中广为使用,但是临床上对于该镇痛模式的效果尚存在较大的争议。 目的：对比连续股神经阻滞和常规静脉自控镇痛方法在人工全膝关节围置换期的镇痛的效果。 方法：纳入南京医科大学附属淮安第一医院骨科2014年1月至2015年1月收治的单侧人工全膝关节置换患者50例,原发病均为膝关节骨关节炎。按随机数字表法分为两组,对照组采用静脉自控镇痛,试验组采用连续股神经阻滞镇痛。对比观察两组患者置换后的疼痛目测类比评分、不良反应及镇痛满意度评分等。 结果与结论：试验组患者置换后4,12,24,48,72 h目测类比评分均显著低于对照组(P < 0.05)。试验组置换后48-72 h内镇痛辅助药物应用率为4%,显著低于对照组24%(P < 0.05)。试验组并发症发生率为12%,显著低于对照组48%(P < 0.05);试验组置换后镇痛满意率为88%,显著高于对照组60%(P < 0.05)。试验组置换后2,3,4 d及出院时的患肢膝关节活动度均显著大于对照组(P < 0.05);试验组置换后住院时间显著短于对照组(P < 0.05)。提示连续股神经阻滞多模式镇痛在人工全膝关节围置换期镇痛效果理想,不良反应发生率低,患者满意度高,是人工全膝关节置换后理想的镇痛方案。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

全膝关节置换镇痛:加巴喷丁联合连续股神经阻滞的应用效果

背景:传统的镇痛方法虽然能够缓解全膝关节置换患者疼痛,但是预后较差,药物依赖性较强。因此,临床上研究全膝关节置换围手术期镇痛药物具有重要的意义。目的:探讨加巴喷丁联合连续股神经阻滞对于全膝关节置换的镇痛效果。方法:从内蒙古医科大学附属医院骨科2013年10月至2014年10月收治的因膝关节骨关节炎行全膝关节置换的48例患者进行研究,均采用全身麻醉方式,且麻醉前行股神经阻滞,置换后连接镇痛泵。按照随机数字表法将患者分为两组,对照组采用多模式镇痛,试验组采用加巴喷丁联合连续股神经阻滞镇痛。采用静息、活动目测类比评分对患者疼痛程度进行评分,观察患者置换后生活质量、膝关节活动度及并发症等相关指标。结果与结论:两组置换前静息痛和活动痛差异无显著性意义(P0.05);两组置换后疼痛随着时间延长目测类比评分降低,试验组置换后1,3,7 d以及1个月静息痛和活动痛目测类比评分均显著低于对照组(P0.05)。试验组置换后3-7 d膝关节活动度均显著大于对照组,差异有显著性意义(P0.05)。随访12个月,试验组日常生活能力量表(ADL)评分、躯体功能评分、心理功能评分及社会功能评分均显著高于对照组(P0.05)。试验组并发症发生率显著低于对照组(17%,46%,P0.05)。提示在全膝关节置换围手术期实施加巴喷丁联合连续股神经阻滞镇痛效果理想,尤其是48 h内急性疼痛者,能够促进患者膝关节功能早期恢复,且不良反应少。     

全膝关节置换应用股神经阻滞镇痛与自控静脉镇痛的系统评价

背景：目前对全膝关节置换围手术期采用何种镇痛方法的效果差异存在争议。 目的：系统评价全膝关节置换术中应用股神经阻滞镇痛与患者自控静脉镇痛的疗效和安全性。 方法：全面搜索国内外关于全膝关节置换中应用股神经阻滞镇痛和患者自控静脉镇痛的随机对照研究资料,按照既定的纳入、排除标准,核定检出符合评价标准的文献,提取所需研究数据,采用RevMan 5.0.18软件进行Meta分析。评价指标包括术后24,48 h静息和活动时的目测类比评分、恶心呕吐胃肠道症状发生率、嗜睡等镇静过度发生率以及患者满意率。 结果与结论：纳入随机对照研究19篇,样本共计952膝,股神经阻滞组和患者自控静脉镇痛组分别为481膝和471膝。荟萃分析加权后,股神经阻滞与患者自控静脉镇痛相比,术后24,48 h静息和活动目测类比评分均较低(P < 0.05),无论是单次股神经阻滞还是连续股神经阻滞,差异均有显著性意义。在并发症发生率方面,股神经阻滞术后恶心呕吐及嗜睡发生率低于患者自控静脉镇痛(P < 0.05)。结果提示,全膝关节置换术中采用股神经阻滞镇痛,无论是镇痛效果还是并发症发生率都优于患者自控静脉镇痛,且股神经阻滞镇痛患者满意度较高。但二者间的比较仍需大规模多中心的随机对照试验来进一步研究。     

股神经和硬膜外自控镇痛在全膝关节置换后的作用

背景：全膝关节置换后疼痛是阻碍早期锻炼的主要问题,置换后镇痛有多种方法可供选择,每种镇痛方法均有自身的优缺点,越来越多的学者趋向于神经阻滞和自控镇痛。 目的：比较经股神经自控镇痛和硬膜外自控镇痛在单侧全膝关节置换后镇痛及促进功能恢复效果的差异。 方法：选择ASAⅠ~Ⅲ级单侧膝关节置换患者42例,随机分为股神经自控镇痛组和硬膜外自控镇痛组,每组21例,均在连续硬膜外麻醉下实施置换,置换后连接镇痛泵。置换后4,8,12,24和48 h,采用目测类比法进行疼痛评分,采用Bromage评分法进行运动阻滞评分;分别记录患者在置换后1,2,3 d、1周、1个月患膝关节主动活动的关节活动度以及不良反应发生情况等。 结果与结论：全膝关节置换后两组目测类比评分差异无显著性意义,运动阻滞Bromage评分股神经自控镇痛组低于硬膜外自控镇痛组,而且股神经自控镇痛组不良反应明显低于硬膜外自控镇痛组,早期关节活动度也好于硬膜外自控镇痛组。提示股神经自控镇痛在全膝关节置换后的镇痛效果是安全有效的,有利于置换后功能恢复。     

多模式镇痛在初次全膝关节置换中的应用

背景：全膝关节置换后围置换期急性疼痛广泛存在,阻碍了早期康复锻炼,增加并发症发生。虽然有研究者提出一系列的新方式并证实了其有效性,但滥用药物及神经阻滞的并发症无法避免,寻找一种安全而有效的镇痛方案成为当前关节置换的重要课题。 目的：观察包括关节周围注射复合麻醉药物的多模式镇痛方案在全膝关节置换患者中的疗效及安全性。 方法：回顾性分析2009-05/2011-05常州市中医医院骨科收治的行单侧全膝关节置换患者80例,分为2组,对照组(n=38),接受股神经阻滞或硬膜外自控镇痛治疗;实验组(n=42),采用包括关节周围注射复合麻醉药物的多模式镇痛方案。 结果与结论：在置换后6 h,12 h,24 h,2 d,3 d内,实验组较对照组疼痛评分降低(P < 0.05)。但在置换后第4,5天两组间疼痛评分差异无显著性意义(P > 0.05)。实验组置换后短期内疼痛减轻明显,置换后主动、被动屈膝90°时间明显缩短,且助行器辅助下地行走时间明显提前(P < 0.05)。两组不良反应发生率相似,由于引流合理使用,未见伤口感染或延迟愈合出现。提示多模式镇痛方案可作为一种安全镇痛方案,能显著减少置换后疼痛。     

Periaqueductal gray stimulation suppresses spontaneous pain behavior in rats

Methods for evaluating analgesic effect for spontaneous pain are increasingly important because it is reported by most patients with neuropathic pain. The present study assessed the analgesic effects of periaqueductal gray (PAG) stimulation in the spared nerve injury (SNI) model of neuropathic pain of the rat. Spontaneous rapid paw withdrawal movements were used as the index of spontaneous pain. Deep-brain stimulation in the PAG was performed in rats 3 weeks after SNI. Significant analgesic effects on spontaneous pain behavior were observed at the same stimulation parameter that reversed the reduced mechanical threshold of the von Frey test. Both analgesic effects lasted 30-40min beyond the 3min stimulation period. In summary, PAG stimulation was effective in alleviating spontaneous pain and mechanical allodynia in the SNI rat. The frequency of spontaneous paw lifting, a behavioral index of spontaneous pain used in this study, will be useful for future testing of therapeutic methods.     

The frequency and characteristics of chronic widespread pain in general practice: a case–control study

BACKGROUND: Chronic widespread pain is common in the community but is not often diagnosed in primary care. One explanation may be that widespread pain is presented and treated in primary care as multiple episodes of regional pain. AIM: To determine whether patients who consult with multiple regional pain syndromes have characteristics consistent with chronic widespread pain. DESIGN OF STUDY: Case-control study. SETTING: One general practice in North Staffordshire, UK. METHOD: Participants were 148 cases who consulted regularly with different musculoskeletal pains over 5 years, and 524 controls who had not consulted for musculoskeletal pain during the same period. A postal questionnaire survey and medical record review were undertaken. RESULTS: Cases with musculoskeletal pain reported more health problems and higher levels of fatigue than controls, and significantly worse general health and greater sleep disturbance (odds ratios 3.3. and 3.1, respectively). They generally reported more severe symptoms and consulted more frequently for a range of problems, but this was not explained by a general propensity to consult. CONCLUSION: Patients who consult in primary care with multiple regional pain syndromes have similar characteristics to those associated with chronic widespread pain and fibromyalgia. Recognising the need for general approaches to pain management, rather than treating each syndrome as a regional problem of pain, may improve the outcome in such patients.     

Unmasking the mysteries of the habenula in pain and analgesia

The habenula is a small bilateral structure in the posterior-medial aspect of the dorsal thalamus that has been implicated in a remarkably wide range of behaviors including olfaction, ingestion, mating, endocrine and reward function, pain and analgesia. Afferent connections from forebrain structures send inputs to the lateral and medial habenula where efferents are mainly projected to brainstem regions that include well-known pain modulatory regions such as the periaqueductal gray and raphe nuclei. A convergence of preclinical data implicates the region in multiple behaviors that may be considered part of the pain experience including a putative role in pain modulation, affective, and motivational processes. The habenula seems to play a role as an evaluator, acting as a major point of convergence where external stimuli is received, evaluated, and redirected for motivation of appropriate behavioral response. Here, we review the role of the habenula in pain and analgesia, consider its potential role in chronic pain, and review more recent clinical and functional imaging data of the habenula from animals and humans. Even through the habenula is a small brain structure, advances in structural and functional imaging in humans should allow for further advancement of our understanding of its role in pain and analgesia.     

鞘内注射M_ERK2-shRNA腺病毒对糖尿病神经痛小鼠的影响

目的 探讨细胞外调节蛋白激酶2 (ERK2）在糖尿病神经病理性疼痛（DNP）小鼠模型中的作用机制。方法40只小鼠随机分4组：对照组,DNP组,siERK2-DNP组（鞘内注射M_ERK2-shRNA腺病毒）,siRNA-DNP组（鞘内注射siRNA腺病毒）。模型制作成功后检测痛阈值;模型制作前、模型制作后2周、 4周及6周检测机械痛阈值;6周后取脊髓组织,利用Western blotting及免疫组织化学法检测脊髓后角ERK2及核因子κB (NFκB)的表达。 结果 与对照组比较,DNP组和siRNA-DNP组痛阈值显著降低, ERK2、NFκB的表达显著上调（P<0.05）,siERK2-DNP组与对照组比较,痛阈值无显著变化, ERK2、NFκB的表达无显著差别（P>0.05）。 结论 下调ERK2可能是治疗糖尿病神经病理性疼痛的脊髓后角神经元损伤的方法之一。     

The effects of morphine on basal neuronal activities in the lateral and medial pain pathways

Numerous studies indicate that morphine suppresses pain-evoked activities in both spinal and supraspinal regions. However, little is known about the effect of morphine on the basal brain activity in the absence of pain. The present study was designed to assess the effects of single-dose morphine on the spontaneous discharge of many simultaneously recorded single units, as well as their functional connections, in the lateral pain pathway, including the primary somatosensory cortex (SI) and ventral posterolateral thalamus (VPL), and medial pain pathway, including the anterior cingulate cortex (ACC) and medial dorsal thalamus (MD), in awake rats. Morphine (5 mg/kg) was administered intraperitoneally before the recording. Naloxone plus morphine and normal saline injections were performed respectively as controls. The results showed that morphine administration produced significant changes in the spontaneous neuronal activity in more than one third of the total recorded neurons, with primary activation in the lateral pathway while both inhibition and activation in the medial pathway. Naloxone pretreatment completely blocked the effects induced by morphine. In addition, the correlated activities between and within both pain pathways was exclusively suppressed after morphine injection. These results suggest that morphine may play different roles in modulating neural activity in normal vs. pain states. Taken together, this is the first study investigating the morphine modulation of spontaneous neuronal activity within parallel pain pathways. It can be helpful for revealing neuronal population coding for the morphine action in the absence of pain, and shed light on the supraspinal mechanisms for preemptive analgesia.     

Calcium-permeable acid-sensing ion channel in nociceptive plasticity: A new target for pain control

The development of chronic pain involves increased sensitivity of peripheral nociceptors and elevated neuronal activity in many regions of the central nervous system. Much of these changes are caused by the amplification of nociceptive signals resulting from the modulation and altered expression of specific ion channels and receptors in the central and peripheral nervous system. Understanding the processes by which these ion channels and receptors are regulated and how these mechanisms malfunction may lead to new treatments for chronic pain. Here we review the contribution of the Ca²⁺-permeable acid-sensing ion channel (ASIC_Ca) in the development and persistence of chronic pain, and the potential underlying mechanisms. Accumulating evidence suggests that ASIC_Ca represents an attractive new target for developing effective therapies for chronic pain.     

Gender dependent effect of DHCR24 polymorphism on the risk for Alzheimer's disease

Although neuroimmune interactions associated with the development of pain sensitization in models of neuropathic pain have been widely studied, there are some aspects that require further investigation. Thus, we aimed to evaluate whether the local intraneural or perineural injections of dexamethasone, an efficacious anti-inflammatory and immunosuppressant drug, delays the development of both thermal hyperalgesia and mechanical allodynia in an experimental model of neuropathic pain in rats. Hargreaves and electronic von Frey tests were applied. The chronic constriction injury (CCI) of right sciatic nerve was performed. Single intraneural dexamethasone administration at the moment of constriction delayed the development of sensitization for thermal hyperalgesia and mechanical allodynia. However, perineural administration of dexamethasone, at the highest dose, did not delay experimental pain development. These results show that inflammation/immune response at the site of nerve lesion is an essential trigger for the pathological changes that lead to both hyperalgesia and allodynia. In conclusion, this approach opens new opportunities to study cellular and molecular neuroimmune interactions associated with the development of pain derived from peripheral neuropathies.     

首诊眼科的真菌性鼻窦炎的影像解剖学特点

目的　分析以眼部症状为主的真菌性鼻窦炎的影像解剖学特征及临床表现。 方法　选取2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的真菌性鼻窦炎患者285例中首诊于眼科的20例患者的临床资料,分析其特征及临床误诊的原因。 结果　该20例首诊于眼科的病例其病变主要位于筛窦3例,蝶窦2例,上颌窦合并筛窦3例,筛窦合并蝶窦8例,上颌窦合并筛窦、蝶窦4例,眼部症状主要为单侧眼胀痛、视力下降、视野改变、面部疼痛及头痛。 结论　以单侧眼部胀痛及视力改变就诊于眼科的患者,应考虑真菌性鼻窦炎的可能,及时给予鼻窦CT检查后转耳鼻咽喉科进行治疗。