影响外伤性视神经病变视力预后的相关因素分析

目的:分析影响外伤性视神经病变视力预后的相关因素。方法:回顾分析40例外伤性视神经病变患者的临床资料,将伤后2d内是否接受激素治疗,伤后有无光感,有无意识障碍,是否有额颞部受伤,有无眶内积血和或眼眶骨折,患者年龄,是否合并其它眼外伤及是否有蝶、筛窦积血等8个变量纳入研究,通过单因素分析(χ2检验)和多因素分析(Logistic回归分析),筛选出影响外伤性视神经病变视力预后的危险因素。结果:经过正规疗程的大剂量激素治疗以后,23/40例视力无改善。在所研究的8个指标中,伤后无光感(P=0.002RR=2.333,95%CI1.348～4.039)、伤后出现意识障碍(P=0.030RR=1.795,95%CI1.120～2.889)和有蝶、筛窦积血(P=0.001RR=2.537,95%CI1.412～4.558)3个指标有统计学意义且进入Logistic回归方程。结论:伤后无光感、意识障碍和蝶、筛窦积血是影响外伤性视神经病变视力预后的危险因素。

Analysis of relevant factors affecting the visual prognosis of traumatic optic neuropathy

AIM:To analyze the effective factors of visual prognosis of traumatic optic neuropathy.METHODS:Forty cases of traumatic optic neuropathy were analyzed retrospectively.Univariate analysis(Chi-square test) and logistic regression were performed to filter the risk factors to the visual prognosis of traumatic optic neuropathy.Eight variables were tested,including corticosteriod treatment in 2 days after trauma,no light perception,frontal or temple trauma,orbital hemorrhage and/or fracture,disturbance of consciousness,age ,other ocular trauma and presence of blood within the sphenoidal or ethmoidal sinus.RESULTS:Twenty-three of 40 cases were invalid after megadosage corticosteroid treatment.Three variables showed a significantly increased risk for no recovery of visual acuity:no light perception(P=0.002 RR=2.333,95%CI 1.348-4.039);disturbance of consciousness(P=0.030 RR=1.795,95%CI 1.120-2.889);presence of blood within the sphenoidal or ethmoidal sinus(P=0.001 RR=2.537,95%CI 1.412-4.558).The three factors above were also proved to be significant in logistic regression.CONCLUSION:No light perception,disturbance of consciousness and presence of blood within the sphenoidal or ethmoidal sinus are the risk factors to the visual prognosis of traumatic optic neuropathy.