视网膜静脉微穿刺注入组织型纤溶酶原激活剂治疗视网膜静脉阻塞的实验研究  

Experiment study of infusing tPA in retinal vein for treatment of retinal vein occlusion

作　　者：胡运韬[1] 马志中[2] 张晓丽 韩素义 黄丽杰[5] 

机构地区：[1]海军总医院眼科,北京100037 [2]北京大学第三医院北京大学眼科中心 [3]山西省晋城市人民医院眼科 [4]解放军总医院眼科 [5]解放军总医院实验动物中心

出　　处：《中华眼科杂志》2003年第11期645-649,共5页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金资助项目 (3 9870 798)

摘　　要：目的　探讨活体视网膜静脉微穿刺注入组织型纤溶酶原激活剂 (tPA)治疗视网膜静脉阻塞的效果及其并发症的防治。方法　将 30只 (30只眼 )小型猪随机分为空白组 (8只眼 )、对照组 (8只眼 )及治疗组 (14只眼 )。均于猪耳缘静脉注入光敏剂Rosebengal(2 0mg/kg体重 ) 1min后 ,借助眼内光照明探头诱导视网膜中央静脉血栓形成。空白组观察视网膜静脉阻塞自然病程变化 ;对照组采用自行研制的微操作器行视网膜静脉微穿刺 ,注入灭菌注射用水 ,观察液体进入阻塞静脉远端对血栓和视网膜组织的影响 ;治疗组亦使用自制的微操作器 ,于视网膜静脉内注入tPA(用灭菌注射用水稀释至 0 1mg/L) ,观察血栓溶解及视网膜组织恢复情况。实验中同时观察视网膜静脉微穿刺和注药过程中可能发生的并发症。结果　行视网膜静脉微穿刺手术 2 2只眼 ,成功 18只眼 (81 4 % ) ;除意外终止手术外 ,9只眼视网膜静脉内注入tPA ,7只眼溶栓成功 (77 8% )。空白组主要表现为静脉远端视网膜出血、水肿 ,静脉怒张 ,随着时间的推移 ,视网膜组织崩解破坏 ;治疗组血栓溶解脱落后 ,视网膜出血水肿迅速吸收 ,7d后组织学检查恢复正常 ;对照组则显示单纯注入灭菌注射用水不能使血栓脱落 ,当大量注入阻塞的视网膜静脉远端后 ,将加重组织水肿 ,甚至导致渗出?Objective To Investigate the effectiveness and complications of injection of tissue plasminogen activator into a retinal vein for treatment of retinal vein occlusion via micropuncture of the retinal vein. Methods Thirty miniature pigs (one eye of each pig) were produced photodynamic thrombi of retinal vein by injecting Rose bengal (20 mg/kg) into the ear vein, and randomly divided into three groups: (1) control ( n =8), (2) infusion of sterile water ( n =8) or (3) infusion of tissue-type plasminogen activator ( n =14) in obstructed retinal vein. In the first group no micropuncture of retinal vein was performed. In the others micropuncture of retinal vein were performed by a micromanipulator that we designed and sterile water was infused in retinal vein in the second group or tissue-type plasminogen activator was infused in the third one. Fluorescent angiography and histological study were performed to document the morphological alterations with clinical observations. Results 18 eyes were successfully performed micropuncture of retinal vein in the 22 eyes (81.4%). Except stopping operation due to surgical accident, there were 7 eyes that the thrombi were lysed in 9 eyes by infusion of tissue-type plasminogen activator in obstructed retinal vein (77.8%). If the micropipette was not accurate for puncturing the vessels, the vessels' wall could be ruptured and hemorrhage appeared. If thrombi of retinal veins were lysed, no bleeding and no leakage of the infused drug were observed from the site of micropuncture after micropipette was withdrawn from the vessel. Sterile water failed to flush the clot downstream. When the thrombus failed to be dislodged, the infusion fluid would back flow into the distal retinal vein and, an exudative retinal detachment would occur. In the first group, the retina exhibited hemorrhages and edema due to the vein occluded. In the second group, sterile water resulted in exaggerated retinal edema and exudative retinal detachment. In the third group, after thrombi of retinal veins were ly

关 键 词：视网膜静脉微穿刺注入 组织型纤溶酶原激活剂 治疗 视网膜静脉阻塞 实验研究 

分 类 号：R774.1[医药卫生—眼科]