尿激酶动脉溶栓对非动脉炎性视网膜中央动脉阻塞患者的疗效和安全性  

Efficacy and safety of urokinase in arterial thrombolytic therapy of non-arteritic central retinal artery occlusion

作　　者：雷涛 王润生 张博 王小堂 马腾 王琨 王勇 LEI Tao;WANG Runsheng;ZHANG Bo;WANG Xiaotang;MA Teng;WANG Kun;WANG Yong(Department of Ophthalmology,Xi’an People’s Hospital(Xi’an Fourth Hospital),Xi’an 710004,Shaanxi Province,China)

机构地区：[1]西安市人民医院(西安市第四医院)眼科,陕西省西安市710004

出　　处：《眼科新进展》2023年第3期198-202,共5页Recent Advances in Ophthalmology

基　　金：陕西省重点研发计划项目(编号:2021SF-154);西安市科技计划项目(编号:21YXYJ0043)。

摘　　要：目的 探讨尿激酶动脉溶栓治疗非动脉炎性视网膜中央动脉阻塞(NA-CRAO)患者的有效性和安全性。方法 回顾性研究。577例(577眼)NA-CRAO患者纳入研究,其中,男424例,女153例,年龄21~80(58.04±12.68)岁,发病时间2~240(89.88±76.51)h。治疗前均行荧光素眼底血管造影(FFA)检查,记录臂-视网膜循环时间(A-Rct)及视网膜主干-末梢充盈时间。所有患者均行尿激酶动脉溶栓治疗,24 h后复查FFA,记录并对比治疗前及治疗后30 d最佳矫正视力(BCVA)。观察治疗中及治疗后并发症发生情况。结果 577例NA-CRAO患者治疗前及治疗后24 h的A-Rct分别为(31.48±0.99)s、(20.99±0.55)s,差异具有统计学意义(P=0.000);治疗前及治疗后24 h主干-末梢充盈时间分别为(73.32±8.05)s、(20.74±3.28)s,差异具有统计学意义(P=0.001);治疗后30 d的BCVA(logMAR)为1.46±0.14,较治疗前2.19±0.32明显改善,差异具有统计学意义(P=0.037)。577例NA-CRAO患者尿激酶动脉溶栓治疗后共有4例发生并发症,其中急性脑梗死1例,急性脑出血2例,短暂性脑缺血1例。结论 尿激酶动脉溶栓治疗发病时间≤240 h的NA-CRAO患者有效,并且有较高的安全性。Objective To investigate the efficacy and safety of urokinase arterial thrombolytic therapy of non-arteritic central retinal artery occlusion(NA-CRAO). Methods A retrospective study was carried out. Totally 577 patients(577 eyes) with NA-CRAO were included in the study. Among them, there were 424 males and 153 females, ranging from 21 to 80(58.04±12.68) years old. The onset time was 2-240(89.88±76.51) h. Before treatment, fundus fluorescein angiography(FFA) was performed to record the arm-retinal circulation time(A-Rct) and main-branch terminal filling time. All patients underwent urokinase arterial thrombolytic therapy. FFA was performed 24 h after the treatment, and best corrected visual acuity(BCVA) before and 30 d after the treatment were recorded and compared. The complications during and after the treatment were observed. Results The A-Rct of 577 NA-CRAO patients before and 24 h after treatment were(31.48±0.99) s and(20.99±0.55) s, respectively, and the difference was statistically significant(P=0.000). Main-branch terminal filling time before and 24 h after treatment were(73.32±8.05) s and(20.74±3.28) s, respectively, and the difference was statistically significant(P=0.000). The BCVA(logMAR) at 30 d after treatment was 1.46±0.14, which significantly improved from 2.19±0.32 before treatment(P=0.037). After the urokinase arterial thrombolytic therapy, complications occurred in 4 patients, including acute cerebral infarction of 1 patient, acute cerebral hemorrhage of 2 patients, and transient cerebral ischemia of 1 patient. Conclusion The urokinase arterial thrombolytic therapy is effective for NA-CRAO within 240 h of onset with high safety.

关 键 词：非动脉炎性视网膜中央动脉阻塞 尿激酶动脉溶栓 荧光素眼底血管造影 

分 类 号：R774.1[医药卫生—眼科]