摘要目的 观察静脉溶栓治疗经动脉溶栓治疗后疗效欠佳的视网膜中央动脉阻塞(CRAO)的临床效果.方法 经动脉溶栓治疗后效果不甚理想的CRAO患者24例24只眼纳入研究.其中,男性11例,女性13例.年龄35～80岁,平均年龄(56.7±15.6)岁.均为单眼发病;右眼11只,左眼13只.所有患眼均采用国际标准视力表检测视力,荧光素眼底血管造影检测臂-视网膜循环时间(A-Rct)及视网膜动脉主干-分支末梢充盈时间.患眼视力光感～0.5,平均视力0.04±0.012.A-Rct 18.0～35.0 s,平均A-Rct(29.7±5.8)s.视网膜动脉主干-分支末梢充盈时间4.0～16.0s,平均时间(12.9±2.3)s.所有患者行尿激酶静脉溶栓治疗.尿激酶用量为3000 U/kg·次,2次/d,加入250 ml的0.9％氯化钠液体中静脉滴注.2次间隔8～10h,连续治疗5d后重复行FFA检测.对比分析静脉溶栓治疗前后患眼视力及A-Rct、视网膜动脉主干-分支末梢充盈时间的改变,并行x2检验.结果 静脉溶栓治疗后患眼A-Rct 16.0～34.0 s,平均A-Rct(22.4±5.5)s.24只眼中,A-Rct27.0～34.0 s4只眼,占16.67％;18.0～26.0 s 11只眼,占45.83％;16.0～17.0 s 9只眼,占37.50％.患眼视网膜动脉主干-末梢充盈时间2.4～16.0 s,平均时间(7.4±2.6)s.与静脉溶栓治疗前比较,静脉溶栓治疗后患眼A-Rct平均缩短7.3 s,视网膜动脉主干-末梢充盈时间平均缩短5.5s,差异均有统计学意义(x2=24.6、24.9,P＜0.01).静脉溶栓治疗后患眼视力光感～0.6,平均视力0.08±0.011.其中,光感1只限,占4.17％;手动至数指/20 cm 8只眼,占33.33％;0.02～0.05者11只眼,占45.83％;0.1～0.2者2只眼,占8.33％;0.5者1只眼,占4.17％;0.6者1只眼,占4.17％.与静脉溶栓治疗前比较,19只眼视力有不同程度改善,占79.17％.静脉溶栓治疗前后患眼视力比较,差异有统计学意义(x2=7.99,P＜0.05).所有患者治疗过程中及治疗后均未见全身不良反应.结论 静脉溶栓治疗经动脉溶栓治疗后疗效欠佳的CRAO能进一步改善患眼视网膜动脉循环,提高视力.

abstractsObjective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy.Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study.There were 11 males and 13 females.The age was ranged from 35 to 80 years,with the mean age of (56.7± 15.6) years.There were 11 right eyes and 13 left eyes.The visual acuity was tested by standard visual acuity chart.The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA).The visual acuity was ranged from light sensation to 0.5,with the average of 0.04±0.012.The A-Rct was ranged from 18.0 s to 35.0 s,with the mean of (29.7±5.8) s.The FT was ranged from 4.0 s to 16.0 s,with the mean of (12.9±2.3) s.All patients were treated with urokinase intravenous thrombolytic therapy.The dosage ofurokinase was 3000 U/kg,2 times/d,adding 250 ml of 0.9％ sodium chloride intravenous drip,2 times between 8-10 h,and continuous treatment of FFA after 5 days.Comparative analysis was performed on the visual acuity of the patients before and after treatment,and the changes of A-Rct and FT.Results After intravenous thrombolytic therapy,the A-Rct was ranged from 16.0 s to 34.0 s,with the mean of (22.4 ±5.5) s.Among 24 eyes,the A-Rct was 27.0-34.0 s in 4 eyes (16.67％),18.0-26.0 s in 11 eyes (45.83％);16.0-17.0 s in 9 eyes (37.50％).The FT was ranged from 2.4 s to 16.0 s,with the mean of (7.4± 2.6) s.Compared with before intravenous thrombolytic therapy,the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences （x2=24.6,24.9;P＜0.01).After intravenous thrombolytic therapy,the visual acuity was ranged from light sensation to 0.6,with the average of 0.08 ± 0.011.There were 1 eye with vision of light perception (4.17％),8 eyes with hand movement/20 cm (33.33％),11 eyes with 0.02-0.05 (45.83％),2 eyes with 0.1-0.2 (8.33％),1 eye with 0.5 (4.17％) and 1 eye with 0.6 (4.17％).The visual acuity was improved in 19 eyes (79.17％).The difference of visual acuity before and after intravenous thrombolytic therapy was significant (x2=7.99,P＜0.05).There was no local and systemic adverse effects during and after treatment.Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.