目的 观察尿激酶静脉溶栓为主的治疗方法对视网膜中央动脉阻塞(CRAO)的疗效.方法 115例经眼底和荧光素眼底血管造影(FFA)检查确诊且临床资料完整的CRAO患者纳入研究.其中,男性61例,女性54例.年龄41～75岁,平均年龄(56.7±15.2)岁.均为单眼发病,病程1～30 d.静脉溶栓治疗为3000 U/kg尿激酶静脉滴注,2次/d,连续治疗6～7 d;地塞米松2.5 mg球后注射,1次/2 d,连续治疗14d.后续治疗为1.2 mg/kg脑蛋白水解物、360 mg曲克芦丁静脉滴注,1次/d,连续治疗14d.观察静脉溶栓治疗以及后续治疗对视力的影响以及静脉溶栓治疗对视网膜动脉充盈时间的影响.治疗后视力较治疗前提高3行以上为显效;较治疗前提高2行为有效;无变化或变化在1行内或下降为无效.以FFA作为视网膜循环恢复的判定指标,分为显效、有效、无效3种情况.其中,臂视网膜循环时间(A Rct)≤15s和视网膜中央动脉各分支在2 s内全部充盈为显效;A Rct较治疗前缩短但在15～20 s,其各分支动脉充盈时间3～8 s为有效;A-Rct虽较治疗前缩短但仍≥21s,其各分支动脉充盈时间≥9 s为无效.分析年龄、性别、病程以及后续治疗时间与疗效的关系.结果 尿激酶静脉内溶栓治疗后FFA复查的79例患者中,11例治疗前为完全阻塞,溶栓治疗后其中8只眼显示视盘表面的血管逆行充盈消失,A-Rct 28～54 s,视网膜动脉主干末梢充盈时间18～55 s;3只眼造影3～4 min内仍显示视盘表面的血管逆行充盈.68例不完全阻塞者A Rct恢复正常35例,占51.5％;有效18例,占26.5％;无效15例,占22.0％;溶栓治疗后视网膜循环时间短于治疗前,差异有统计学意义(x2 =11.4,P＜0.05).尿激酶静脉内溶栓治疗前后视力分布比较,差异有统计学意义(x2＝12.1,P＜0.05).后续治疗后最终视力与尿激酶静脉内溶栓治疗后视力分布比较,差异有统计学意义(x2＝14.6,P＜0.05);其中,48只眼视力提高2行甚至2行以上,占41.7％.后续治疗后最终视力与治疗前视力分布比较,差异有统计学意义(x2 =44.5,P＜0.05).其中,视力改变为显效者58只眼,占 50.4％;有效者35只眼,占30.4％;无效者22只眼,占19.2％.不同年龄段患者有效率比较,差异无统计学意义(x2=4.8,P＞0.05).男性患者与女性患者有效率比较,差异无统计学意义(x2 ＝2.6,P＞0.05).病程7d内者76例,显效者43例,有效者22例,有效率85.5％;病程8～15 d者25例,显效者11例,有效者8例,有效率76.0％;病程超过15d者14例,显效者4例,有效者5例,有效率64.3％.后续治疗7d者30例,显效13例,有效8例,有效率70.0％;后续治疗8～14 d者34例,显效18例,有效9例,有效率79.4％;后续治疗15～21 d者51例,显效27例,有效者18例,有效率88.2％.结论 以尿激酶静脉溶栓为主的治疗方法可有效治疗CRAO.
目的 觀察尿激酶靜脈溶栓為主的治療方法對視網膜中央動脈阻塞(CRAO)的療效.方法 115例經眼底和熒光素眼底血管造影(FFA)檢查確診且臨床資料完整的CRAO患者納入研究.其中,男性61例,女性54例.年齡41～75歲,平均年齡(56.7±15.2)歲.均為單眼髮病,病程1～30 d.靜脈溶栓治療為3000 U/kg尿激酶靜脈滴註,2次/d,連續治療6～7 d;地塞米鬆2.5 mg毬後註射,1次/2 d,連續治療14d.後續治療為1.2 mg/kg腦蛋白水解物、360 mg麯剋蘆丁靜脈滴註,1次/d,連續治療14d.觀察靜脈溶栓治療以及後續治療對視力的影響以及靜脈溶栓治療對視網膜動脈充盈時間的影響.治療後視力較治療前提高3行以上為顯效;較治療前提高2行為有效;無變化或變化在1行內或下降為無效.以FFA作為視網膜循環恢複的判定指標,分為顯效、有效、無效3種情況.其中,臂視網膜循環時間(A Rct)≤15s和視網膜中央動脈各分支在2 s內全部充盈為顯效;A Rct較治療前縮短但在15～20 s,其各分支動脈充盈時間3～8 s為有效;A-Rct雖較治療前縮短但仍≥21s,其各分支動脈充盈時間≥9 s為無效.分析年齡、性彆、病程以及後續治療時間與療效的關繫.結果 尿激酶靜脈內溶栓治療後FFA複查的79例患者中,11例治療前為完全阻塞,溶栓治療後其中8隻眼顯示視盤錶麵的血管逆行充盈消失,A-Rct 28～54 s,視網膜動脈主榦末梢充盈時間18～55 s;3隻眼造影3～4 min內仍顯示視盤錶麵的血管逆行充盈.68例不完全阻塞者A Rct恢複正常35例,佔51.5％;有效18例,佔26.5％;無效15例,佔22.0％;溶栓治療後視網膜循環時間短于治療前,差異有統計學意義(x2 =11.4,P＜0.05).尿激酶靜脈內溶栓治療前後視力分佈比較,差異有統計學意義(x2＝12.1,P＜0.05).後續治療後最終視力與尿激酶靜脈內溶栓治療後視力分佈比較,差異有統計學意義(x2＝14.6,P＜0.05);其中,48隻眼視力提高2行甚至2行以上,佔41.7％.後續治療後最終視力與治療前視力分佈比較,差異有統計學意義(x2 =44.5,P＜0.05).其中,視力改變為顯效者58隻眼,佔 50.4％;有效者35隻眼,佔30.4％;無效者22隻眼,佔19.2％.不同年齡段患者有效率比較,差異無統計學意義(x2=4.8,P＞0.05).男性患者與女性患者有效率比較,差異無統計學意義(x2 ＝2.6,P＞0.05).病程7d內者76例,顯效者43例,有效者22例,有效率85.5％;病程8～15 d者25例,顯效者11例,有效者8例,有效率76.0％;病程超過15d者14例,顯效者4例,有效者5例,有效率64.3％.後續治療7d者30例,顯效13例,有效8例,有效率70.0％;後續治療8～14 d者34例,顯效18例,有效9例,有效率79.4％;後續治療15～21 d者51例,顯效27例,有效者18例,有效率88.2％.結論 以尿激酶靜脈溶栓為主的治療方法可有效治療CRAO.
목적 관찰뇨격매정맥용전위주적치료방법대시망막중앙동맥조새(CRAO)적료효.방법 115례경안저화형광소안저혈관조영(FFA)검사학진차림상자료완정적CRAO환자납입연구.기중,남성61례,녀성54례.년령41～75세,평균년령(56.7±15.2)세.균위단안발병,병정1～30 d.정맥용전치료위3000 U/kg뇨격매정맥적주,2차/d,련속치료6～7 d;지새미송2.5 mg구후주사,1차/2 d,련속치료14d.후속치료위1.2 mg/kg뇌단백수해물、360 mg곡극호정정맥적주,1차/d,련속치료14d.관찰정맥용전치료이급후속치료대시력적영향이급정맥용전치료대시망막동맥충영시간적영향.치료후시력교치료전제고3행이상위현효;교치료전제고2행위유효;무변화혹변화재1행내혹하강위무효.이FFA작위시망막순배회복적판정지표,분위현효、유효、무효3충정황.기중,비시망막순배시간(A Rct)≤15s화시망막중앙동맥각분지재2 s내전부충영위현효;A Rct교치료전축단단재15～20 s,기각분지동맥충영시간3～8 s위유효;A-Rct수교치료전축단단잉≥21s,기각분지동맥충영시간≥9 s위무효.분석년령、성별、병정이급후속치료시간여료효적관계.결과 뇨격매정맥내용전치료후FFA복사적79례환자중,11례치료전위완전조새,용전치료후기중8지안현시시반표면적혈관역행충영소실,A-Rct 28～54 s,시망막동맥주간말소충영시간18～55 s;3지안조영3～4 min내잉현시시반표면적혈관역행충영.68례불완전조새자A Rct회복정상35례,점51.5％;유효18례,점26.5％;무효15례,점22.0％;용전치료후시망막순배시간단우치료전,차이유통계학의의(x2 =11.4,P＜0.05).뇨격매정맥내용전치료전후시력분포비교,차이유통계학의의(x2＝12.1,P＜0.05).후속치료후최종시력여뇨격매정맥내용전치료후시력분포비교,차이유통계학의의(x2＝14.6,P＜0.05);기중,48지안시력제고2행심지2행이상,점41.7％.후속치료후최종시력여치료전시력분포비교,차이유통계학의의(x2 =44.5,P＜0.05).기중,시력개변위현효자58지안,점 50.4％;유효자35지안,점30.4％;무효자22지안,점19.2％.불동년령단환자유효솔비교,차이무통계학의의(x2=4.8,P＞0.05).남성환자여녀성환자유효솔비교,차이무통계학의의(x2 ＝2.6,P＞0.05).병정7d내자76례,현효자43례,유효자22례,유효솔85.5％;병정8～15 d자25례,현효자11례,유효자8례,유효솔76.0％;병정초과15d자14례,현효자4례,유효자5례,유효솔64.3％.후속치료7d자30례,현효13례,유효8례,유효솔70.0％;후속치료8～14 d자34례,현효18례,유효9례,유효솔79.4％;후속치료15～21 d자51례,현효27례,유효자18례,유효솔88.2％.결론 이뇨격매정맥용전위주적치료방법가유효치료CRAO.
Objective To observe the effects of intravenous thrombolysis with urokinase for centralretinal artery occlusion (CRAO).Methods A total of 115 CRAO patients diagnosed by fluorescence fundus angiography (FFA) were enrolled in this study.The patients included 61 males and 54 females,with a mean age of (56.7±15.2) years (from 41 to 75 years).The duration ranged from 1 to 30 days.All the patients were affected unilaterally.All the patients were received the treatment of intravenous thrombolysis with urokinase (3000 U/kg,two times per day,continuous treatment for six to seven days) and retrobulbar injection of dexamethasonc 2.5 mg (one time per day,continuous treatment for 14 days).Following that,1.2 mg/kg brain protein hydrolysate (nerve nutrition) and 360 mg troxerutin (vasodilator) were given by intravenous drip (one time per day,continuous treatment for 14 days).Effectiveness of the thrombolytic and subsequent treatments including the recovery of vision and retinal arterial filling time before and after treatment were observed.Comparing the visual acuity of post treatment and pre-treatment,improving three lines or more is considered as effective markedly,improving two lines as effective,no change or a decline as no effect.With FFA as the retinal circulation recovery index,the arm-retinal circulation time (A-Rct) ≤ 15s and all branches of central retinal artery were filled with fluorescence within 2s filling (normal) as effective markedly; A-Rct improved but was in 15～20s range,all branches of central retinal artery were filled with fluorescence within 3～ 8s as effective; A Rct improved but was still ≥ 21s,all branches of central retinal artery were filled with fluorescence within ≥9s as no effect.The relationship between age,gender,the disease course,subsequent treat time and curative effectiveness were analyzed.Results There were 79 patients were examined for FFA again after thromholysis treatment which including 11 patients with complete obstruction and 68 patients with incomplete obstruction.In 11 patients with complete obstruction,eight patients showed that optic disc vascular retrograde filling disappeared,A Rct was 28-54s,and the filling time from retinal artery to tip was18-55s; three patients showed persistent optic disc vascular retrograde filling within 3-4 minutes of FFA.In 68 patients with incomplete obstruction,A-Ret returned to normal in 35 patients (51.4％),effective in 18 patients (26.5％) and no effect in 15 patients (22.1％).Retinal circulation time was shorter than that before thrombolysis treatment (x2 =11.4,P＜0.05).Comparison of distribution of visual acuity before and after thrombolysis treatment,the difference was statistically significant (x2=12.1,P＜0.05).Comparison of distribution of final visual acuity after subsequent treatment with that of after thrombolysis treatment,48 eyes improved two lines or more,the efficiency was 41.7％,the difference was statistically significant (x2 =14.6,P＜0.05).Comparison to that of before treatment,vision changes showed effect markedly in 58 patients (50.4％),effective in 35 patients (30.4％),no effect in 22 patients (19.2％),the difference was statistically significant (x2 =44.5,P＜0.05).Comparison the average age to that of effective,valid and invalid patients,the difference was not statistically significant (t=0.98,1.17,0.55; P＞0.05).There was no relationship between effectiveness and gender (x2=2.6,P＞0.05).In 76 patients with duration within seven days,43 patients were effective markedly and 22 patients were effective,the efficiency was 85.5％.In 25 patients with duration of 8-15 days,11 patients were effective markedly and eight patients were effective,the efficiency was 76.0％.In 34 patients who received subsequent treatment 8-14 days,18 patients were effective markedly and nine patients were effective,the efficiency was 79.4％.In 51 patients who received subsequent treatment 15-21 days,27 patients were effective markedly and 18 patients were effective,the efficiency was 88.2％.Conclusion Intravenous thrombolysis with urokinase was effective in the treatment of CRAO.
