眼动脉分支逆行介入溶栓治疗视网膜中央动脉阻塞疗效观察  

Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion

作　　者：王润生[1] 钱路[2] 王毅[3] 郑轶[3] 杜善双[1] 雷涛[2] 吕沛霖[1] 王文军[1] 

机构地区：[1]西安市第四医院眼科,710004 [2]西安市第四医院神经内科,710004 [3]西安市第四医院介入科,710004

出　　处：《中华眼底病杂志》2016年第4期377-381,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察眼动脉分支逆行介入溶栓治疗视网膜中央动脉阻塞（CRAO）的疗效。 方法 经眼底彩色照相及荧光素眼底血管造影（FFA）检查确诊为CRAO的14例患者14只眼纳入研究。其中，男性8例，女性6例。年龄35～80岁，平均年龄（56.7±20.3）岁。发病时间 9～72 h，平均发病时间22 h。视力无光感4只眼，光感5只眼，手动5只眼。眼压14~20 mmHg（1 mmHg=0.133 kPa），平均眼压19 mmHg。确诊后均参照急性脑梗死溶栓治疗适应证和禁忌症行眼动脉分支逆行介入溶栓治疗。眉弓内下角皮肤切开分离暴露出滑车上动脉，从该动脉插入带导丝的微导管，在数字减影血管造影（DSA）观察下用同轴微导管技术经滑车上动脉间歇性注入尿激酶，总用量为40万U；溶栓过程中注入罂粟碱30 mg。介入溶栓结束即在DSA下观察眼动脉及其分支较溶栓前有无血管增粗、循环改善。介入治疗后48 h内行FFA检查观察视网膜血液循环改变情况。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。A-Rct≤15 s和视网膜动脉主干-末梢在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，视网膜中央动脉主干-末梢血管充盈时间3～8 s为有效；A-Rct虽较治疗前缩短但仍≥21 s，视网膜中央动脉主干-末梢血管充盈时间≥9 s为无效。视力较治疗前提高3行以上为显效，提高2行为有效，变化在1行以内或下降为无效。治疗后随访5～21 d，平均随访时间16 d。随访观察患者视力改善程度以及眼部、全身不良反应发生情况。 结果 14只眼经滑车上动脉导管插入均获得成功。插管成功后DSA可见眼动脉显示良好，颈内动脉和颈总动脉无显影。微导管注入溶栓药物后DSA显示眼动脉及其分支增粗、循环较溶栓前加快2 s者5只眼，3 s者6只眼，4 s者3只眼；且眼环显影较溶栓前更明�Objective To observe the clinical effect of the ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion （CRAO）. Methods Fourteen CRAO patients （14 eyes） were enrolled in this study, including 8 males and 6 females. The age was ranged from 35 to 80 years old,with an average of （56.7±20.3） years. The duration of occurrence after the onset was 9 to 72 hours, with a mean of 22 hours. There were 4 eyes with vision of no light perception, 5 eyes with light perception and 5 eyes with hand movement. The intraocular pressure was ranged from 14 - 20 mmHg （1 mmHg=0.133 kPa）, with an average of 19 mmHg. All the patients received the treatment of ophthalmic artery branch retrograde interventional therapy according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Micro catheters was inserted into the exposed arteries from a skin incision below the eyebrow under guidance of digital subtraction angiography （DSA）, urokinase （total 0.4 million U） and papaverine 30 mg were injected into the arteries. After artery thrombolysis, the changes of DSA, filling time of retinal artery and its branches on fluorescence fundus angiography （FFA） within 48 hours and the visual acuity were observed. According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly （improving 3 lines or more）, effective （improving 2 lines） and no effect （change within 1 line 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）. The follow up ranged from 5 to 21days, with a mean of 6 days. Th

关 键 词：视网膜动脉闭塞/药物疗法 血栓溶解疗法 放射摄影术 介入性 血管造影术 数字减影 荧光素血管造影术 

分 类 号：R774.1[医药卫生—眼科]