纤维蛋白溶酶联合透明质酸酶治疗玻璃体积血的实验研究  

An experimental study on plasmin combined hyaluronidase treatment vitreous hemorrhage

作　　者：于亚杰[1] 安明[2] 陈惠茹[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]青岛市市立医院东院眼科

出　　处：《眼科》2010年第5期340-343,共4页Ophthalmology in China

摘　　要：目的研究纤维蛋白溶酶联合透明质酸酶对玻璃体积血的治疗效果。设计实验性研究。研究对象40只兔(40眼)。方法将40只兔随机分为A、B、C、D组,每组10只,右眼作为实验眼。取自体耳缘静脉血0.1 ml注射入玻璃体腔内形成玻璃体积血模型,24小时后A组玻璃体腔内注射纤维蛋白溶酶1 U+透明质酸酶20 U(0.1 ml);B组纤维蛋白溶酶1 U(0.1 ml);C组透明质酸酶20 U(0.1 ml);D组BSS溶液0.1 ml。术后7天内行间接检眼镜对眼底各象限透明度观察并分级,各象限分级数值总和为玻璃体积血指数,评价玻璃体积血吸收情况;行B超、扫描电镜检查玻璃体后脱离(PVD)发生情况。主要指标玻璃体积血指数、完全性玻璃体后脱离发生率。结果注射后7天各组玻璃体积血指数中位数及四分位间距分别为:A组4(2～5.25);B组7(6～8);C组10(10～11);D组12(10～12)。各组玻璃体积血指数两两比较A组与B、C、D组的差异均有统计学意义(P均<0.01)。B超显示各组完全性PVD发生率:A组10例(100%),B组8例(80%),C组及D组均未发生。结论 1 U纤维蛋白溶酶联合20 U透明质酸酶玻璃体内联合注射可有效促进玻璃体内积血团块的分解,并可有效地液化玻璃体诱导PVD,加速血液的播散和吸收。Objective To investigate the effect of plasmin combined with hyaluronidase in the treatment of vitreous hemorrhage. Design Experimental study. Participants 40 rabbits （40 eyes）. Methods 40 rabbits （40 eyes） were randomly divided into four groups. Each group consisted of 10 rabbits （10 eyes）. 0.1 ml fresh blood from their ear vain was injected into vitreous cavity to form the vitreous hemorrhage model. After 24 hours, vitreous injection was performed using 1 U of plasmin and 20 U of hyaluronidase for group A, 1 U of plasmin for group B, 20 U of hyaluronidase for group C, and 0.1 ml of BSS for group D. Seven days after injection, eyes were examined by indirect fundus ophthalmoscope and graded based on the vitreous transparency in each quadrant. The vitreous hemorrhage index was the sum of scores in each quadrant. B ultrasonic scan and transmission electronic microscope were used to evaluate the degree of posterior vitreous detachment （PVD）. Main Outcome Measures Vitreous hemorrhage index and incidence rate of PVD. Results After 7 days, the median and 25% to 75% quartile range of vitreous hemorrhage index was 4 （2-5.25） in group A, 7（6-8） in group B, 10（10-11） in group C, and 12 （10-12） in group D. The difference between group A and other groups is significant （P〈0.01）. We examined incidence of PVD by B mode ultrasonic. Rate for group A, group B, goup D was 100%, 80%, 0% and 0%, respectively. Conclusions Vitreous injection of 1 U of fibrinolysin combined with 20 U of hyaluronidase was effective in degenerating blood clot, liquefing vitreous haemorrhage clot, inducing PVD, promoting dispersion, absorpting of blood, and protecting retina.

关 键 词：玻璃体积血 纤维蛋白溶酶 透明质酸酶 

分 类 号：R779.6[医药卫生—眼科]