CAJ | 학술논문

目的观察超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞(CRAO)的临床效果.方法临床确诊为CRAO的12例患者12只眼纳入研究.其中,男性7例,女性5例;年龄19～68岁,平均年龄(50.0±3.5)岁.发病时间8～72 h,平均发病时间18h.应用同轴微导管技术进行超选择性眼动脉或选择性颈动脉微量泵持续泵入尿激酶,总用量为20～40万U;溶栓过程中注入罂粟碱30 mg.12例患者中,行超选择性眼动脉溶栓治疗5例;因经济原因行选择性经颈内动脉溶栓治疗4例;因眼动脉纤细,微导管插入困难无法完成超选择性眼动脉溶栓治疗改行颈内动脉溶栓治疗2例,颈内动脉和颈外动脉联合溶栓1例.治疗后行视力和荧光素眼底血管造影(FFA)检查判定疗效.以治疗后视力较治疗前提高3行及以上为显效;较治疗前提高2行为有效,治疗前后视力无变化、变化在1行以内或下降为无效.以臂-视网膜循环时间(A-Rct)和视网膜动脉主干-末梢充盈时间为视网膜循环恢复的判定标准.以A-Rct≤15 s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16～20 s以内,视网膜中央动脉各分支充盈时间3～8 s为有效;A-Rct虽较治疗前缩短但仍≥21 s,视网膜中央动脉各分支充盈时间≥9 s为无效.结果视力检查结果显示,12只眼中,显效5只眼,占41.7％;有效5只眼,占41.7％;无效2只眼,占16.6％.总有效率为83.4％.所有患眼治疗后视网膜循环情况较治疗前明显改善.FFA检查结果显示,12只眼中,显效8只眼,占67.0％;有效4只眼,占33.0％.总有效率为100.0％.所有患者治疗及随访过程中均未发生穿刺部位血肿、颅内出血、脑栓塞等并发症,也未发生眼球活动异常、眼底出血及玻璃体积血等不良反应.结论超选择性眼动脉溶栓治疗CRAO可取得较好疗效;对于部分眼动脉解剖异常和不宜采用超选择性眼动脉溶栓治疗者,选择性颈内动脉溶栓治疗也可取得相似效果. 目的觀察超選擇性眼動脈及選擇性頸內動脈溶栓治療視網膜中央動脈阻塞(CRAO)的臨床效果.方法臨床確診為CRAO的12例患者12隻眼納入研究.其中,男性7例,女性5例;年齡19～68歲,平均年齡(50.0±3.5)歲.髮病時間8～72 h,平均髮病時間18h.應用同軸微導管技術進行超選擇性眼動脈或選擇性頸動脈微量泵持續泵入尿激酶,總用量為20～40萬U;溶栓過程中註入罌粟堿30 mg.12例患者中,行超選擇性眼動脈溶栓治療5例;因經濟原因行選擇性經頸內動脈溶栓治療4例;因眼動脈纖細,微導管插入睏難無法完成超選擇性眼動脈溶栓治療改行頸內動脈溶栓治療2例,頸內動脈和頸外動脈聯閤溶栓1例.治療後行視力和熒光素眼底血管造影(FFA)檢查判定療效.以治療後視力較治療前提高3行及以上為顯效;較治療前提高2行為有效,治療前後視力無變化、變化在1行以內或下降為無效.以臂-視網膜循環時間(A-Rct)和視網膜動脈主榦-末梢充盈時間為視網膜循環恢複的判定標準.以A-Rct≤15 s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16～20 s以內,視網膜中央動脈各分支充盈時間3～8 s為有效;A-Rct雖較治療前縮短但仍≥21 s,視網膜中央動脈各分支充盈時間≥9 s為無效.結果視力檢查結果顯示,12隻眼中,顯效5隻眼,佔41.7％;有效5隻眼,佔41.7％;無效2隻眼,佔16.6％.總有效率為83.4％.所有患眼治療後視網膜循環情況較治療前明顯改善.FFA檢查結果顯示,12隻眼中,顯效8隻眼,佔67.0％;有效4隻眼,佔33.0％.總有效率為100.0％.所有患者治療及隨訪過程中均未髮生穿刺部位血腫、顱內齣血、腦栓塞等併髮癥,也未髮生眼毬活動異常、眼底齣血及玻璃體積血等不良反應.結論超選擇性眼動脈溶栓治療CRAO可取得較好療效;對于部分眼動脈解剖異常和不宜採用超選擇性眼動脈溶栓治療者,選擇性頸內動脈溶栓治療也可取得相似效果.
목적 관찰초선택성안동맥급선택성경내동맥용전치료시망막중앙동맥조새(CRAO)적림상효과.방법 림상학진위CRAO적12례환자12지안납입연구.기중,남성7례,녀성5례;년령19～68세,평균년령(50.0±3.5)세.발병시간8～72 h,평균발병시간18h.응용동축미도관기술진행초선택성안동맥혹선택성경동맥미량빙지속빙입뇨격매,총용량위20～40만U;용전과정중주입앵속감30 mg.12례환자중,행초선택성안동맥용전치료5례;인경제원인행선택성경경내동맥용전치료4례;인안동맥섬세,미도관삽입곤난무법완성초선택성안동맥용전치료개행경내동맥용전치료2례,경내동맥화경외동맥연합용전1례.치료후행시력화형광소안저혈관조영(FFA)검사판정료효.이치료후시력교치료전제고3행급이상위현효;교치료전제고2행위유효,치료전후시력무변화、변화재1행이내혹하강위무효.이비-시망막순배시간(A-Rct)화시망막동맥주간-말소충영시간위시망막순배회복적판정표준.이A-Rct≤15 s화시망막중앙동맥각분지재2 s내전부충영위현효;A-Rct교치료전축단단재16～20 s이내,시망막중앙동맥각분지충영시간3～8 s위유효;A-Rct수교치료전축단단잉≥21 s,시망막중앙동맥각분지충영시간≥9 s위무효.결과 시력검사결과현시,12지안중,현효5지안,점41.7％;유효5지안,점41.7％;무효2지안,점16.6％.총유효솔위83.4％.소유환안치료후시망막순배정황교치료전명현개선.FFA검사결과현시,12지안중,현효8지안,점67.0％;유효4지안,점33.0％.총유효솔위100.0％.소유환자치료급수방과정중균미발생천자부위혈종、로내출혈、뇌전새등병발증,야미발생안구활동이상、안저출혈급파리체적혈등불량반응.결론 초선택성안동맥용전치료CRAO가취득교호료효;대우부분안동맥해부이상화불의채용초선택성안동맥용전치료자,선택성경내동맥용전치료야가취득상사효과.
Objective To observe the clinical effect of super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion (CRAO).Methods Twelve CRAO patients (12 eyes) were enrolled in this study.The patients included 7 males and 5 females.The age was ranged from 19 to 68 years old,with an average of (50.0t3.5) years.The disease duration was from 8 to 72 hours,with a mean of 18 hours.All the patients were received the treatment of super-selective ophthalmic artery or selective carotid artery thrombolysis with urokinase (total 0.20-0.4 million U) and injection of papaverine 30 mg.Five patients received the treatment of super-selective ophthalmic artery thrombolytic therapy,7 patients received the treatment of selective carotid artery thrombolytic therapy (4patients because of the financial issues,3 patients because of thin ophthalmic artery).According to the visual acuity of post-treatment and pre-treatment,the therapeutic effects on vision were defined as effective markedly (improving three lines or more),effective (improving two lines) and no effect (no change or a decline).According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA),the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s,FT 2 s),effective (A-Rct was improved but in the range of 16-20 s,FT was in 3-8 s) and no effect (A-Rct was improved but 21 s,FT 9 s).Results The vision changes showed effective markedly in 5 eyes (41.7％),effective in 5 eyes (41.7％),no effect in 2 eyes (16.6 ％).The total therapeutic efficiency on vision was 83.4％.The retinal circulation was improved in all eyes after treatment,including effective markedly in 8 eyes (67.0％),effective in 4 eyes (33.0％).The total therapeutic efficiency on retinal circulation was 100.0％.No complications occurred in these 12 patients during the treatment or follow up,such as puncture site hematoma,intracranial hemorrhage,cerebral embolism,eye movement abnormalities,retinal and vitreous hemorrhage.Conclusion Super-selective ophthalmic artery and selective carotid artery thrombolytic therapy were effective in the treatment of CRAO.