静脉纤溶治疗视网膜中央动脉阻塞动脉溶栓无效者的效果  

Efficacy of intravenous fibrinolysis after ineffective arterial thrombolysis for central retinal artery occlusion

作　　者：杨平孙 刘一帆 Yang Pingsun;Liu Yifan(Department of Ophthalmology,Xiaoshan Hospital of Traditional Chinese Medicine,Hangzhou 311201,China)

机构地区：[1]浙江省杭州市萧山区中医院眼科,杭州311201

出　　处：《中华眼外伤职业眼病杂志》2022年第10期752-756,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察静脉纤溶治疗视网膜中央动脉阻塞(CRAO)经动脉溶栓后效果不佳者的临床效果。方法回顾性病例系列研究。纳入杭州市萧山区中医院2016年1月至2020年1月起病5 h之内经动脉溶栓治疗1 d后效果不佳的CRAO 19例(19眼)作为研究对象。所有患者均为单眼发病且在动脉溶栓之前均未接受任何治疗;均采用生理盐水250 ml加入尿激酶3 000 U/kg静脉滴注进行纤溶, 2次/d, 间隔期8~10 h, 注射5 d后再进行检查。观察荧光素眼底血管造影(FFA)结果、视力及视野等。结果 FFA显示:静脉纤溶前臂-视网膜循环时间为(29.9±5.9)s, 纤溶后缩短至(21.3±4.9)s (t=26.13, P=0.032)。纤溶前视网膜动脉循环时间为(13.1±2.1)s, 纤溶后缩短为(7.2±2.4)s (t=25.31, P=0.018)。静脉纤溶前最佳矫正视力(logMAR)为0.92±0.05, 纤溶后升至0.76±0.03(t=9.68, P=0.012)。纤溶前视野缺损小于30%者占15.79%(3/19), 纤溶后升至63.16%(12/19)(P=0.021)。结论动脉溶栓后效果不佳的CRAO患者再行静脉滴注纤溶可进一步提升视力、缩短视网膜循环时间及改善视野。Objective To observe the clinical efficacy of intravenous fibrinolysis for the treatment of central retinal artery occlusion(CRAO)after transarterial thrombolysis with poor outcomes.Methods This was a retrospective case series study.A total of 19 eyes of 19 patients with CRAO with poor outcome after 1 day of transarterial thrombolysis treatment within 5 hours of onset from Jan.2016 to Jan.2020 in the Xiaoshan Hospital of Traditional Chinese Medicine were enrolled in this study.All patients were monocular in onset and did not receive any treatment prior to arterial thrombolysis.All cases received urokinase of 3000 U/kg intravenously in 250 ml of physilogicalsaline 2 times/day with an interval of approximately 8-10 hours,and the injections were repeated 5 days later for examination.The fundus fluorescein angiography(FFA)results,the visual acuity and visual feild were observed.Results FFA results showed that Fibrinolytic forearm retinal circulation time was(29.9±5.9)seconds before introvenous fibrinolysis and shortened to(21.3±4.9)seconds after fibrinolysis(t=26.13,P=0.032).Retinal arterial circulation time was(13.1±2.1)seconds before intravenous fibrinolysis and shortened to(7.2±2.4)seconds after fibrinolysis(t=25.31,P=0.018).The best corrected visual acuity(logMAR)was 0.92±0.05 before intravenous fibrinolysis and rose to 0.76±0.03 after fibrinolysis(t=9.68,P=0.012).The proporticn of visual field defects less than 30%were 15.79%(3/19)before fibrinolysis,and incrised to 63.16%(12/19)after fibrinolysis(P=0.021).Conclusion Intravenous fibrinolysis canfurther improve visual acuity,shorten retinal circulation time and improve visual field in patients with ineffective CRAO after arterial thrombolysis.

关 键 词：阻塞 动脉 中央 视网膜 纤溶 静脉 溶栓 动脉 

分 类 号：R774.1[医药卫生—眼科]