【摘要】 目的：探讨急性后天性眼外肌麻痹的临床特征和治疗方法。方法：对21例急性后天性眼外肌麻痹经详细询问病史、详细查体和眼科检查，给予球后或球旁注射地塞米松和6542，静滴血塞通注射液或复方丹参注射液、能量合剂等。结果：本组21例急性后天性眼外肌麻痹中外伤引起者(肌源性)15例(71%)，血管性病变引起者(神经源性)6例(29%)。均因复视首诊。治愈17例，显效4例。结论：急性后天性眼外肌麻痹早期积极药物治疗可取得显著效果。
【关键词】 眼外肌;麻痹;后天性;药物治疗
Clinical analysis of 21 cases of acute acquired extraocular muscles paralysisGuoHua Yang, XiaoPing Zhang, Hong HuangDepartment of Ophthalmology and Otorhinolaryngology, No.546 Hospital of Chinese PLA, Urumchi 841700, Xinjiang Uygur Autonomous Region, ChinaAbstractAIM: To explore the clinical feature and therapeutic method of acute acquired extraocular muscles paralysis.METHODS: The detailed medical record, system and ophthalmology medical examination were performed in 21 cases of acute acquired extraocular muscles paralysis and then dexamethasone and 6542 were injected behind or beside the eyeball, and the xuesaitong or complex salviae parenteral solution and energy mixture were dripped in vein. RESULTS: There were 15 cases (71%) induced by surgical trauma (neurogenic paralysis), and 6 cases(29%) by the blood vessel pathological changes (muscular paralysis). All cases saw doctor firstly because of ambiopia. 17 cases fully recovered from the illness and 4 cases excellently recovered from the illness. CONCLUSION: The significant effect can be gained by early and positive drug treatment.
KEYWORDS: extraocular muscles; paralysis; acquired; drug treatment
0引言
急性后天性眼外肌麻痹是眼科常见病，分为神经源性、肌源性、机械性和全身免疫性4类，现将我科收治的以复视为首发症状的21例患者的病因及治疗效果分析如下。
1对象和方法
1.1对象
本组21例21眼，其中外伤引起者15例(71%)，男13例，女2例，年龄12～38岁。主要症状为外伤后双眼复视，其中右眼6眼(上直肌麻痹2眼，下直肌麻痹2眼，下斜肌麻痹2眼)，左眼9眼(外直肌麻痹2眼，下直肌麻痹2眼，下斜肌麻痹5眼)。行CT检查未见眼外肌断离。无外伤史者6例(男3例，女3例)，年龄44～65岁，1例无基础性疾病，5例患高血压病(其中1例为高血压病+糖尿病)。无外伤史者发生复视时均有血压升高和明显的头痛。无外伤史的6例中左眼1例(动眼神经麻痹)，右眼5例(下斜肌麻痹2例，下直肌麻痹2例，外直肌麻痹1例)。
1.2方法
详细询问病史，行全身检查，眼科检查：单眼视力、双眼视力、验光、眼球运动情况、红玻璃试验、裂隙灯、眼底镜检查。有外伤史的行眼眶CT扫描，以了解眼球、眼眶、眼外肌及副鼻窦情况，证实眼外肌有无断离及嵌顿。无外伤史的6例中4例行CT检查，未见异常。21例21眼均瞳孔回避。确定麻痹肌后，球后或球旁注射地塞米松注射液2.5mg+6542 2mg+利多卡因注射液0.1mL。静滴能量合剂、血塞通注射液或复方丹参注射液，口服B族微生素、肌苷。有基础性疾病者用药方案请相关专业制定。随访6～36(平均18)mo。疗效判定标准：治愈：眼位正，眼球活动正常，双眼9个诊断眼位注视时无复视。显效：正前方注视时复视消失，麻痹肌作用方向注视时复像距离明显缩小，眼球活动自如或轻度受限。有效：眼位偏斜及眼球运动较入院时好转，正前方注视及麻痹肌作用方向注视时复像距离缩小。无效：眼球运动和正前方注视及麻痹肌作用方向注视时复像距离无变化。
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