脑卒中患者视觉受损和视力康复的临床分析

目的 调查脑卒中患者视觉受损的类型和视力康复情况.方法 经神经内科确诊为脑卒中的患者,检查其眼科疾病和视功能状态,尤其是视力的矫正和康复.结果 547例脑卒中视觉受损患者中、斜视或眼球运动受损者占47.0%,视野受损者占34.0%,19.0%的患者有视知觉缺陷,19.9%的患者有低视力或盲,用手持放大镜康复后.脱盲率为35.7%,脱残率为58.2%,屈光矫正前后平均视力分别为0.36±0.34、0.48±0.36(t=-3.949,P=0.03)、戴望远镜前后低视力患者平均视力分别为0.13±0.007和0.46±0.26(t=-5.208.P=0.01)、盲患者平均视力分别为0.01±0.01和 0.06±0.05(t=-3.628,P=0.05),差异有统计学意义(均P＜0.01).结论 72%的脑卒中患者均有某种程度上的视功能受损,这不仅影响患者的独立生活能力,还直接影响其临床康复治疗效果.屈光矫正和配戴望远镜是视力康复的有效手段,临床医生应重视脑卒中患者视功能的康复和治疗.

Investigation of visual impairment and its rehabilitation following stroke

Objective To investigate the visual impairment and its rehabilitation after stroke.Methods After diagnosis of stroke by the neurologists, the patients received examinations of ocular pathology and visual function, especially in vision correction and rehabilitation. Results Five hundred and forty-seven stroke patients were recruited. 47.0% of the patients had eye alignment/movement impairment, 34.0% had visual field impairment, 19. 0% had visual perceptual difficulties and 19.9% had low vision blind. After using telescope, 35.7% blind patient's distance vision was ≥0.05; 58.2% low vision patient's distance vision was ≥0.3. After refraction (average vision:0.36±0.34 vs. 0.48 ±0.36,t =- 3.949,P=0.03) or using telescope(average vision of patients had low vision:0. 13±0. 07 vs. 0. 46±0.26,t=-5. 208,P=0.01 ;average vision of blind patients:0. 01 ±0.01 vs. 0. 06±0. 05,t = -3. 628, P= 0. 05), the improvement of vision for patients was significant.Conclusions The 72% of stroke patients has some kinds of visual impairment, which will affect not only the patients' independent living but also the clinical rehabilitation. Refraction and using telescope are effective for vision rehabilitation. Doctors should pay much attention to the visual therapy and rehabilitation for the stroke patients.