星状神经节阻滞对缺血性视神经病疗效的评价

目的 比较星状神经节阻滞(SGB)及肾上腺皮质激素治疗缺血性视神经病(ION)的疗效。方法 诊断明确的ION病人70例82眼,随机分为激素组和SGB组。其中激素组34例38眼(地塞米松15mg静脉滴注,每日1次;5～10d后改用强的松20mg顿服,每日1次);SGB治疗组36例44眼(2％利多卡因2～3ml,患眼同侧行SGB,每日1次,10～15d为1疗程);以视力提高、眼底改变、视野变化以及视觉诱发电位(VEP)的改变作为疗效的指标。结果 激素组治疗后显效10眼,有效12眼,好转3眼,无效13眼,总有效率为65.8％。治疗前、后视力为0.26±0.21、0.35±0.26,差异有显著性(P<0.05)。SGB组治疗后显效15眼,有效14眼,好转5眼,无效10眼,总有效率为77.3％。治疗前、后视力为0.26±0.21、0.44±0.23,差异有显著性(P<0.01);与激素组治疗后视力比较,差异有显著性(P<0.05)。两组病人治疗后VEP P_(100)波的潜时明显缩短,振幅明显升高,与治疗前比较,P<0.05;SGB组治疗后振幅升高较激素组明显(P<0.05)。治疗后两组大部分病人眼底视盘水肿逐渐消退,视网膜颜色、血管逐渐恢复常态,视野基本恢复正常,受损的视神经功能得到恢复。结论 星状神经节阻滞是治疗缺血性视神经病变较安全、有效的方法。

Stellate ganglion block for ischemic optic neuropathy: a comparison with steroids

Objective To evaluate the efficacy of stellate ganglion block ( SGB) in the treatment of ischemic optic neuropathy ( ION ) as compared with that of steroids. Methods Eighty-two eyes were involved in seventy patients with ION. The patients were randomly assigned to receive either steroids (dexamethason 15 mg iv q.d. for 5-10 days followed by peroral prednisone 20 mg q.d.) ( n = 34, 38 eyes) or ipsilateral SGB (2% lidocaine 2-3 ml q.d. 10-15 days) ( n = 36, 44 eyes). The criteria for judging the efficacy of the treatment were changes in visual acuity, ocular fundus, visual field and visual evoked potential (VEP) . The effectiveness of the treatment was divided into four grades : excellent, good, improved and no effect. Results In steroid group the results of treatment were rated as excellent for 10, good for 12, improved for 3 and no effect for 13 eyes (the overall success rate was 65.8%), while in SGB group the results were rated as excellent for 15, good for 14, improved for 5 and no effect for 10 eyes ( the overall success rate was 77.3 % ). In patients who were successfully treated, the visual acuity improved, the pale edema of optic papilla was disappearing and the color and blood vessels of retina were returning to normal. The latent time of VEP P100 was significantly shortened and the amplitude increased in both groups. Conclusion SGB is a safe, reliable and effective method of treatment for ION.