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眼底出血(一)

西医的认识: 顾名思义,眼底出血是一种临床表现,并不是一种病名,引起眼底出血的原因很多,如高血压视网膜病变、糖尿病视网膜病变、眼底动脉血管瘤、视网膜静脉栓塞、眼外伤等等,均可导致眼底出血。由于各种不同的病因导致相同的病理损害,如视网膜出血,渗出,微血管瘤、新生血管等。 本病由于病因复杂,所以病程长,易反复发作,严重影响视力,引起诸多严重的并发症。如黄斑病变(黄斑囊样水肿、黄斑变性),新生血管性青光眼、玻璃体积血、视神经萎缩、增殖性视网膜病变、牵拉性视网膜脱离,如不及时有效的治疗,常可导致失明。

中医的认识: 中医解释眼底出血属于中医血证范畴,《灵枢?决气》云:“中焦受气,变化而赤,是谓血。”《景岳全书?杂证谟》云:“凡七窍之灵,为四肢之用……凡形质所在,无非血之用也。”后世医家根据《灵枢?大惑论》记载:“五脏六气之精气,皆上注于目而为之精,精之窠为眼,骨之精为瞳子,筋之精为黑眼,血之精为络,其窠气之精为白眼,肌肉之精为约束,裹颉筋骨血气而与脉并为系,上属于脑,后出于项中。”将其发展中医五轮学说。故眼底出血又属于中医学的“内障”眼病范畴。根据各种眼病病变所引起的不同程度的视功能障碍而有不同的称谓,如“暴盲”、“云雾移睛”、“视瞻昏渺”等本病病程较长,危害诸多,严重影响患者视力,并能引起视网膜脱离等重症。

起病要点:

1、眼底出血的根源,其实质与患者自身血液的质量改变有关。高血脂、高血糖、全血粘度超标、血流动力学下降、血管壁基底膜增厚、无菌杂质沉淀、血管管腔变窄、韧性降低、通透性增加都为眼底出血提供了必备的条件。2、同时由于供血不足导致视网膜及视觉神经系统因缺氧、缺水发生病变。血栓堵塞、管内压增高导致血管渗血或局部破裂也是出血的最直接诱因。 

症状体征:

(1)突然眼前一片漆黑,仅见手动或仅有光感。 (2)骤然间眼前如有圆的黑影遮住,不随眼转动而漂浮,正中方向注视物体完全不见,两旁物体则模糊可见。 (3)突然眼内有如线条状黑影向某一方向直射,进展迅速,且逐渐加多,最后终至遮住眼前,视物一片模糊,无法分辨。 (4)骤然眼前出现红光闪闪,逐渐加多,以致红光满目,视物不明。 (5)发病先兆,多数有眼胀,眼珠跳动等感觉。 (6)多数反复发作,每次发作,亦有以上某些症象,即使积血不退,当继续出血时,还可能有以上的某些感觉。 ? ? ? ?由于眼底出血的原因及部位不同,预后及对患者视力的影响也不一样,依照出血量的多少,出血部位不同而产生不同的症状。如出血量少,位于视乳头及视网膜周边部,可以没有明显的症状,如出血量多,患者感到眼前有黑影浮动,视线被部分或完全遮挡,仅剩光感的视力。如出血位于视网膜中心(黄斑区)患者中心视力丧失,即中心区视物不清有暗影遮挡,周边尚有部分视力

预防及注意事项:

1、预防出血宜用眼适度,不要干重体力活,不要作俯卧撑及剧烈活动,不要长时间看书报、电视,建议看过40分钟后休息2~3分钟,不要过度兴奋、疲劳、激动或恼怒,保持良好和充足的睡眠,避免服用坚硬食物,注意补充含适应维生素类的蔬菜,瓜果。 2、睡眠充足有助于滋润眼睛,减少眼睛的血丝。 3、清洁眼睑,以免因残屑、油脂、细菌、化妆品等尘屑导致眼睛发炎,布满血丝。 4.早点睡,不要等到12点睡,那已经很晚了,最好是10点之前。睡眠时间以8小时为宜。放松点,多做点户外活动。出现眼底出血后首先要卧床休息,避免活动和精神紧张,做好血压、血糖等的控制。 5、要少吸烟、少饮酒,少吃有刺激性的食物,禁喝浓茶或咖啡

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