以尿激酶静脉溶栓为主治疗视网膜中央动脉阻塞115例临床疗效观察  

Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients

作　　者：王润生[1] 吕沛霖[2] 张娅萍[1] 刘安萍 雷晓琴[1] 杜善双[1] 郑波[1] 王文军[1] 雷涛[4] 

机构地区：[1]西安市第四医院眼科,710004 [2]西安市第一医院眼科 [3]西安市碑林区红会医院眼科 [4]西安市第四医院神经内科,710004

出　　处：《中华眼底病杂志》2012年第5期466-471,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：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（CRA（））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1～30d。静脉溶栓治疗为3000U／kg尿激酶静脉滴注，2次／d，连续治疗6～7d；地塞米松2．5mg球后注射，1次／2d，连续治疗14d。后续治疗为1．2mg／kg脑蛋白水解物、360mg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（ARet）≤15S和视网膜中央动脉各分支在2S内全部充盈为显效；ARct较治疗前缩短但在15～20s，其各分支动脉充盈时间3～8S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≥9s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—Rct28～54S，视网膜动脉主下-末梢充盈时间18～55S；3只眼造影3～4min内仍显示视盘表面的血管逆行充盈。68例不完全阻塞者ARct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Objective To observe the effects of intravenous thrombolysis with urokinase for central retinal 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 iniection of dexamethasone 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 hut 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 thrombolysis treatment which including 11 patients with complete obstruct

关 键 词：视网膜动脉闭塞/药物疗法 尿纤溶酶原激活物/治疗应用 尿纤溶酶原激活物/投药和剂量 

分 类 号：R774.1[医药卫生—眼科]