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眼部缺血综合征(OIS)是因慢性严重的颈动脉阻塞或狭窄导致脑和眼供血不足而产生的一系列缺血综合征。该病多发于老年人,且男性病人多于女性。主要的临床症状为视力下降,眶区疼痛,视网膜动脉变窄、静脉扩张、视网膜新生血管形成等;另外眼底荧光血管造影(FFA)显示脉络膜充盈延迟,动静脉期延长,血管着色等;且大多数病人还会出现虹膜新生血管,导致病人视力逐渐完全丧失,严重危害病人的正常生活[1-3]。目前,对于OIS病人眼部情况的影像学检查有CT血管造影(CTA)、磁共振血管造影(MRA)及超声等,各种检测方式都有其优缺点。高频彩超具有易操作、无创伤且波型重复性良好等优点,可对临床疗效进行准确判定,并实时掌握病人病情进展情况[4]。本研究对高频彩超在OIS病人颈动脉血管重建术治疗中的应用价值进行探讨,评估治疗方法,提高临床疗效,使病人尽快恢复正常生活。现作报道。
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治疗前后,反向组病人平均颈动脉狭窄度均高于正向组(P < 0.01);治疗后,2组病人平均颈动脉狭窄度均比治疗前降低(P < 0.01)(见表 1)。
分组 n 治疗前 治疗后 反向组 22 94.24±4.78 40.54±5.47** 正向组 28 82.32±6.81 30.45±5.12** t — 6.97 6.71 P — < 0.01 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 表 1 2组病人治疗前后平均颈动脉狭窄度比较(x±s; %)
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治疗前,反向组病人眼动脉PSV高于正向组,睫状后动脉PSV低于正向组(P < 0.05和P < 0.01),2组视网膜中央动脉PSV差异无统计学意义(P>0.05);治疗后,2组病人眼动脉、睫状后动脉、视网膜中央动脉的PSV均比治疗前升高(P < 0.01),且治疗后正向组眼动脉和睫状后动脉PSV高于反向组,差异有统计学意义(P < 0.05和P < 0.01),而视网膜中央动脉2组差异无统计学意义(P>0.05)(见表 2)。
分组 n 眼动脉 视网膜中央动脉 睫状后动脉 治疗前 反向组 22 27.85±4.97 7.24±2.13 7.74±1.56 正向组 28 23.41±7.21 7.36±2.25 9.54±1.89 t — 2.46 0.19 3.60 P — < 0.05 >0.05 < 0.01 治疗后 反向组 22 33.17±5.54** 15.21±3.01** 14.57±3.34** 正向组 28 37.89±7.46** 15.69±2.88** 18.31±3.46** t — 2.48 0.57 3.85 P — < 0.05 >0.05 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 表 2 2组病人治疗前后眼动脉、视网膜中央动脉和睫状后动脉PSV比较(x±s;cm/s)
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治疗前后,正向组病人最佳矫正视力均高于反向组(P < 0.01);治疗后,正向组病人最佳矫正视力高于治疗前(P < 0.01),而反向组治疗前后病人最佳矫正视力比较差异无统计学意义(P>0.05)(见表 3)。
分组 n 治疗前 治疗后 反向组 22 2.97±0.23 3.05±0.22 正向组 28 3.27±0.25 3.68±0.17** t — 4.36 11.43 P — < 0.01 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 表 3 2组病人治疗前后最佳矫正视力比较(x±s)
高频彩超在眼部缺血综合征病人颈动脉血管重建术治疗中的应用价值
Application value of high frequency color Doppler ultrasound in carotid artery reconstruction of patients with ocular ischemic syndrome
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摘要:
目的研究高频彩超在眼部缺血综合征(OIS)病人颈动脉血管重建术治疗中的应用价值。 方法选取2018年7月至2019年7月行颈动脉血管重建术的OIS病人50例,根据病人眼动脉血流方向不同分为正向血流组(正向组)28例和反向血流组(反向组)22例。分别比较2组病人手术前后平均颈动脉狭窄度、眼部最佳矫正视力及眼动脉、视网膜中央动脉和睫状后动脉的血流动力学改变。 结果治疗前后,反向组病人平均颈动脉狭窄度均高于正向组(P < 0.01);治疗后,2组病人平均颈动脉狭窄度均比治疗前降低(P < 0.01)。治疗前,反向组病人眼动脉PSV高于正向组,睫状后动脉PSV低于正向组(P < 0.05和P < 0.01);治疗后,2组病人眼动脉、睫状后动脉、视网膜中央动脉的PSV均比治疗前升高(P < 0.01),且治疗后正向组眼动脉和睫状后动脉PSV高于反向组(P < 0.05和P < 0.01)。治疗前后,正向组病人最佳矫正视力均高于反向组(P < 0.01);治疗后,正向组病人最佳矫正视力高于治疗前(P < 0.01)。 结论行颈动脉血管重建术后OIS病人平均颈动脉狭窄度及眼动脉、视网膜中央动脉和睫状后动脉的血流动力学均明显改善,且正向组视力明显提高,而反向组无明显改善;高频彩超可准确监测病人手术前后球后主要血管血流动力学的改变,有利于实时掌握病人病情改善情况。 Abstract:ObjectiveTo study the value of high frequency color Doppler ultrasound in carotid artery reconstruction in patients with ocular ischemic syndrome(OIS). MethodsA total of 50 patients with OIS who underwent carotid artery reconstruction from July 2018 to July 2019 were selected and divided into forward flow group(28 cases) and reverse flow group(22 cases) according to the direction of ophthalmic artery blood flow. The mean carotid stenosis, best corrected visual acuity and hemodynamic changes of ophthalmic artery, central retinal artery and posterior ciliary artery were compared between the two groups before and after operation. ResultsBefore and after treatment, the average degree of carotid stenosis in the reverse flow group was higher than that in the forward flow group(P < 0.01). After treatment, the average degree of carotid stenosis in the two groups was lower than that before treatment(P < 0.01). Before treatment, the PSV of ophthalmic artery in the reverse flow group was higher than that in the forward flow group, and the PSV of posterior ciliary artery was lower than that in the forward flow group(P < 0.05 and P < 0.01). After treatment, the PSV of ophthalmic artery, posterior ciliary artery and central retinal artery in the two groups were higher than that before treatment(P < 0.01), and the PSV of ophthalmic artery and posterior ciliary artery in the forward flow group was higher than that in the reverse flow group(P < 0.05 and P < 0.01). Before and after treatment, the best corrected visual acuity in the forward flow group was higher than that in the reverse flow group(P < 0.01). After treatment, the best corrected visual acuity in the forward flow group was higher than that before treatment(P < 0.01). ConclusionsAfter carotid revascularization, the mean carotid stenosis and hemodynamics of ophthalmic artery, central retinal artery and posterior ciliary artery in OIS patients are significantly improved, and the visual acuity in the forward flow group is significantly improved, but not in the reverse flow group. High frequency color Doppler ultrasound can accurately monitor the changes of hemodynamics of main postbulbar blood vessels before and after operation, which is helpful to grasp the improvement of patients' condition in real time. -
表 1 2组病人治疗前后平均颈动脉狭窄度比较(x±s; %)
分组 n 治疗前 治疗后 反向组 22 94.24±4.78 40.54±5.47** 正向组 28 82.32±6.81 30.45±5.12** t — 6.97 6.71 P — < 0.01 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 表 2 2组病人治疗前后眼动脉、视网膜中央动脉和睫状后动脉PSV比较(x±s;cm/s)
分组 n 眼动脉 视网膜中央动脉 睫状后动脉 治疗前 反向组 22 27.85±4.97 7.24±2.13 7.74±1.56 正向组 28 23.41±7.21 7.36±2.25 9.54±1.89 t — 2.46 0.19 3.60 P — < 0.05 >0.05 < 0.01 治疗后 反向组 22 33.17±5.54** 15.21±3.01** 14.57±3.34** 正向组 28 37.89±7.46** 15.69±2.88** 18.31±3.46** t — 2.48 0.57 3.85 P — < 0.05 >0.05 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 表 3 2组病人治疗前后最佳矫正视力比较(x±s)
分组 n 治疗前 治疗后 反向组 22 2.97±0.23 3.05±0.22 正向组 28 3.27±0.25 3.68±0.17** t — 4.36 11.43 P — < 0.01 < 0.01 组内配对t检验: 与治疗前比较**P < 0.01 -
[1] 苏陆青, 王婕, 张月玲, 等. 玻璃体腔注射雷珠单抗联合经巩膜睫状体光凝、全视网膜光凝治疗眼缺血综合征致新生血管性青光眼效果观察[J]. 武警后勤学院学报(医学版), 2018, 27(2): 145. [2] KAMILOV KM, KASIMOVA MS, MAKHKAMOVA DK. Analysis of choline alfoscerate effectiveness in chronic ocular ischemic syndrome[J]. Vestn Oftalmol, 2016, 132(2): 73. doi: 10.17116/oftalma2016132273-76 [3] 杨秀芬, 李红阳, 赵露, 等. 眼缺血综合征的临床及影像学特点分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 119. [4] 张子靖. 颈动脉系统影像学检查在眼缺血综合征中的临床应用[J]. 眼科学报, 2018, 33(2): 113. [5] 李凤鸣. 中华眼科学[M]. 北京: 人民卫生出版社, 2005: 2155. [6] 李萱, 王薇, 黄映湘. 眼缺血综合征介入治疗成功一例[J]. 中华眼科杂志, 2018, 54(3): 221. doi: 10.3760/cma.j.issn.0412-4081.2018.03.014 [7] KIM YH, SUNG MS, PARK SW. Clinical features of ocular ischemic syndrome and risk factors for neovascular glaucoma[J]. Korean J Ophthalmol, 2017, 31(4): 343. doi: 10.3341/kjo.2016.0067 [8] 李肖春, 高颖, 鲍翔, 等. 颈动脉支架成形术对缺血性眼病患者眼部血流动力学改变的临床观察[J]. 中华眼底病杂志, 2018, 34(3): 258. doi: 10.3760/cma.j.issn.1005-1015.2018.03.012 [9] CHANG L, LV D, JIN Y, et al. High-frequency color Doppler ultrasound as the first diagnostic and monitoring choice for early superficial high-flow vascular malformations[J]. J Med Ultrason(2001), 2017, 44(3): 275. doi: 10.1007/s10396-017-0771-z [10] JOHNSON CM, NAVARRO OM. Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 2: vascular malformations[J]. Pediatr Radiol, 2017, 47(9): 1196. doi: 10.1007/s00247-017-3906-x [11] 彭仕龙. 探讨高频彩超在眼部疾病中的诊断价值[J]. 中国医院用药评价与分析, 2016, 16(1): 252. [12] 李对红, 朱媛媛, 侯秀昆, 等. 高频彩超对老年缺血性眼病患者球后血流动力学的研究[J]. 中华老年医学杂志, 2018, 37(11): 1248. doi: 10.3760/cma.j.issn.0254-9026.2018.11.015 [13] 冯雪艳, 牟明春, 陈海婷, 等. 颈动脉支架成形术治疗缺血性眼病的疗效观察[J]. 中国实用眼科杂志, 2015, 33(7): 824. doi: 10.3760/cma.j.issn.1006-4443.2015.07.029