摘要
目的:动眼神经麻痹是多种原因导致的以眼球运动障碍、眼睑位置异常和/或瞳孔受损为特征的疾病。首诊于不同科室的动眼神经麻痹病因不尽相同,本研究分析首诊于眼科的动眼神经麻痹患者的病因、病变定位及预后。方法:回顾性收集2009至2018年首诊于解放军总医院第一医学中心眼科的137例动眼神经麻痹住院患者的临床资料。分析患者的病因及其在各年龄段的分布特点、病变定位、预后。结果:在137例患者中,动眼神经麻痹的病因排名前3位的依次是头部外伤(38.69%)、海绵窦病变(12.40%)、眶内炎症(9.49%),其他病因还包括颅内动脉瘤、颅内占位性病变、脑血管病变、感染、眶内肿瘤、糖尿病、鼻腔术后等。病因中头部外伤多见于20~49岁的青壮年,脑血管病变多见于60~69岁老年人,糖尿病多见于50~69岁中老年人,其余病因类型年龄分布相对平衡。病变定位情况:眶尖病变75例,病因包括外伤、炎症、感染、肿瘤;海绵窦病变40例,病因包括炎症、肿瘤、血栓;蛛网膜下腔病变6例,病因包括动脉瘤、肿瘤、外伤;动眼神经核病变5例,病因为梗死;未见动眼神经束病变。有11例因为病因不明,所以无法定位。治疗后,动眼神经麻痹侧矫正视力改善不明显。颅内动脉瘤、脑血管病变、糖尿病造成的动眼神经麻痹患者上睑下垂及眼球运动障碍部分或完全恢复比例较高。结论:动眼神经麻痹是造成眼肌麻痹及复视的常见病因,首诊于眼科的动眼神经麻痹以头部外伤、海绵窦病变及眶内炎症最为多见。青壮年常见于外伤,而中老年人则常见于糖尿病及脑血管病变等原因导致的动眼神经麻痹。病变位置以发生在眶尖和海绵窦为主。动眼神经麻痹侧矫正视力预后较差,颅内动脉瘤、脑血管病变及糖尿病性动眼神经麻痹患者的上睑下垂及眼球运动障碍预后较好。及时查明病因是治疗动眼
Objective:Oculomotor nerve palsy is a kind of disease with many causes,showing eye movement disorders,abnormal eyelid position,and/or damage of the pupil.The etiology of oculomotor nerve palsy in different departments is different.The study discussed the etiology,localization of the lesion,and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology.Methods:Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology,the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected.The etiology and its distribution characteristics in different age groups,the location of the lesion,and the prognosis of patients were analyzed.Results:In 137 patients,the top 3 causes for oculomotor nerve palsy were head trauma(38.69%),cavernous sinus lesions(12.40%),and orbital inflammation(9.49%).Other causes included intracranial aneurysm,the intracranial space-occupying lesion,cerebral vessel diseases,infection,orbital tumors,diabetes,the operation of nasal cavity.Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years,while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years.The age distribution of other etiological types was relatively balanced.Seventy-five cases of orbital apex lesions were due to trauma,inflammation,infection,and tumor;40 cases of cavernous sinus lesions were due to inflammation,tumor,and thrombosis;6 cases of subarachnoid lesions were due to aneurysms,tumors,and trauma;5 cases were oculomotor nucleus lesions were due to infarction;11 cases could not be allocated because of unknown etiology.After treatment,the corrected visual acuity of oculomotor nerve palsy side was not significantly improved.The patients with oculomotor nerve palsy caused by intracranial aneurysm,cerebrovascular disease,and diabetes mellitus had the highest proportion of partial or com
作者
张馨
魏世辉
ZHANG Xin;WEI Shihui(Department of Ophthalmology,First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Traditional Chinese Medicine),Hangzhou 310001;Department of Ophthalmology,First Medical Center of PLA General Hospital,Beijing 100039,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2020年第12期1425-1430,共6页
Journal of Central South University ：Medical Science
关键词
动眼神经麻痹
病因
病变定位
预后
oculomotor nerve palsy
etiology
localization of the lesion
prognosis
