外伤性视神经病变视力预后的相关因素分析

目的探讨外伤性视神经病变视力预后的影响因素。方法回顾性分析1999年8月—2008年1月中南大学湘雅三医院眼科收治的88例外伤性视神经病变患者临床资料。88例患者以性别、年龄、眼别、伤后有无光感、有无骨折、昏迷史、受伤原因、治疗方式8个临床观察因素作为自变量（X）,疗效作为因变量,进行非条件Logistic回归分析,观察视力预后的影响因素。所有治疗均在患者及家属签署知情同意书后进行。结果单因素分析显示伤后有无光感X4（P=0.010）、昏迷史X6（P=0.010）和治疗方式X8（P=0.006）是视力预后的影响因素。多因素分析显示伤后无光感（OR=3.392,P=0.010）、有昏迷史（OR=3.162,P=0.010）是影响预后的危险因素（χ2=20.333,P=0.000）,手术治疗是保护视力的有力措施（OR=1.459,P=0.006）。Logistic回归方程为：LogistP=-1.674＋1.222X4＋1.151X6＋1.459X8（χ2=20.333,P=0.000）。结论伤后无光感、有昏迷史是影响眼视力预后的危险因素,手术治疗是保护视力的有力措施。

Analysis of relevant factors affecting prognosis of traumatic optic neuropathy

Background Traumatic optic neuropathy leads to severe destruction of visual function.Some literature showed that the incidence of traumatic optic neuropathy following the craniocerebra trauma was 0.5%-5.0%.It is very important for ophthalmologist to understand the risk factor of prognosis in the patients with traumatic optic neuropathy.Objective This study was to analyze the risk factors of traumatic optic neuropathy.Methods The clinical data of eighty-eight patients with traumatic optic neuropathy and follow-up duration for 3 months were retrospectively reviewed in this study.These patients were determined as traumatic optic neuropathy in the Third Xiangya Hospital from August 1999 to January 2008.Sex,age,eyes,visual acuity,fracture,coma and injure reason were defined as independent variable （X）,and curative effect was as dependent variable（Y）.Nonconditional logistic regression analysis was used to investigate the risk factors of traumatic optic neuropathy.Written informed consent was obtained from the patient or family before any medical management.Results Single factor analysis showed the risk factors of traumatic optic neuropathy included visual acuity （P=0.010）,coma （P=0.010） and curative effectiveness （P=0.006）.Nonconditional logistic regression analysis indicated that without light perception（OR=3.392,P=0.010）,coma （OR=3.162,P=0.010） were risk factors of visual outcome affecting traumatic optic neuropathy with the regression equation as follow：Logit P=-1.674＋1.222X4＋1.151X6＋1.459X8 （χ2= 20.333,P=0.000）.Early surgical treatment could rescued the visual acuity in the patients with traumatic optic neuropathy （OR=1.459,P=0.006）.Conclusion Non-light perception,coma are risk factors affecting traumatic optic neuropathy.Early surgical treatment after trauma could effectively protect visual acuity.