老年人糖尿病性眼肌麻痹临床观察.docVIP

老年人糖尿病性眼肌麻痹临床观察 　【摘要】 　　目的：观察老年人糖尿病性眼肌麻痹的临床表现及治疗效果，并探讨其发病机制。方法：对20例眼肌麻痹的老年患者行常规眼科检查和眼肌功能检查，并进行全身及血生化检查确诊为糖尿病后，给予降血糖、对伴高血压者控制血压，同时肌注维生素B1、B12并口服血管扩张剂和小剂量皮质类固醇。结果：所有患者治疗6~12wk后眼球运动正常，复视消失，随访6~8mo，有2例分别在3mo和5mo时复发。 结论：老年人糖尿病性眼肌麻痹的主要表现为复视及上睑下垂，经控制血糖及其它对症支持治疗后，眼肌麻痹均能治愈，但有少数患者在治愈后复发。 【关键词】 糖尿病　眼肌麻痹　老年人 　　Clinical observation of ophthalmoplegia in the aged with diabetes Abstract AIM:To observe clinical situation and therapeutic efficacy of ophthalmoplegia in the aged with diabetes, and to discuss its pathogenetic mechanism. METHODS: In addition to routine ophthalmologic examination and ocular muscle examination, general check-up and blood biochemical examination were also included. Twenty cases of ophthalmoplegia with diabetes were treated with vitamin B1 and B12 and prednisone and drugs of vascular dilatation, meanwhile concentration of blood sugar and hypertension in which were also controlled. RESULTS: After 20 cases had been treated for 6~12 weeks, their ocular movement became normal and the diplopia disappeared, 2 cases of which recurred during follow-up 6~8 months. CONCLUSION: Main manifestations of ophthalmoplegia in the aged with diabetes are diplopia and blepharoptosis, ophthalmoplegia can be cured by drugs, but a few of which will recur. · KEYWORDS: diabetes; ophthalmoplegia; the aged 　　0引言 糖尿病是一种以糖代谢紊乱为主要表现的内分泌疾病，此类患者并发眼肌麻痹的情况临床上较少见，我们总结1997-03/2005-08在门诊治疗的老年人糖尿病性眼肌麻痹患者20例，现报告如下。 1对象和方法 1.1对象 收集1997-03/2005-08在门诊诊治的糖尿病性眼肌麻痹患者共20例，其中男8例，女12例；年龄61~75（平均66.5）岁；既往有糖尿病史11例、病程5~21（平均11.3）a；另有9例出现眼肌麻痹后经检查发现有糖尿病，10例合并糖尿病性视网膜病变，其中6例在出现眼肌麻痹前已确诊为糖尿病性视网膜病变；4例在出现眼肌麻痹后检查时发现糖尿病性视网膜病变，全身检查伴有高血压者15例。临床表现：18例以复视为首发症状，2例因突然出现上睑下垂来就诊，其中12例伴头痛及病侧眼眶或眼球后疼痛，1例同时伴有复视和上睑下垂，20例患者均为单眼发病，其中右眼11例、左眼9例，受累的颅神经有动眼神经12例、外展神经7例，两者同时受累1例。单独外展神经受累的表现：患眼于内收位，向外直肌作用运动方向受限，复视像检查；水平复像距离加大；完全性动眼神经麻痹1例，表现为上睑下垂，眼球外下斜、向内、上、下运动受限，瞳孔散大约5mm，对光反射迟钝，其余11例不完全性动眼神经麻痹表现为内直肌麻痹6例，下直肌麻痹5例，1例外展神经和动眼神经同时受累的表现为上睑下垂、外直肌麻痹。血糖检查：20例患者空腹血糖为7.3～18.2mmol/L，平均12.6mmol/L。头颅CT检查：脑萎缩1例，脑梗塞1例，其余未见异常。 1.2方法 所有患者经化验血糖确诊为糖尿病后