摘要目的 观察尿激酶静脉溶栓为主的治疗方法对视网膜中央动脉阻塞(CRAO)的疗效.方法 115例经眼底和荧光素眼底血管造影(FFA)检查确诊且临床资料完整的CRAO患者纳入研究.其中,男性61例,女性54例.年龄41～75岁,平均年龄(56.7±15.2)岁.均为单眼发病,病程1～30 d.静脉溶栓治疗为3000 U/kg尿激酶静脉滴注,2次/d,连续治疗6～7 d;地塞米松2.5 mg球后注射,1次/2 d,连续治疗14d.后续治疗为1.2 mg/kg脑蛋白水解物、360 mg曲克芦丁静脉滴注,1次/d,连续治疗14d.观察静脉溶栓治疗以及后续治疗对视力的影响以及静脉溶栓治疗对视网膜动脉充盈时间的影响.治疗后视力较治疗前提高3行以上为显效;较治疗前提高2行为有效;无变化或变化在1行内或下降为无效.以FFA作为视网膜循环恢复的判定指标,分为显效、有效、无效3种情况.其中,臂视网膜循环时间(A Rct)≤15s和视网膜中央动脉各分支在2 s内全部充盈为显效;A Rct较治疗前缩短但在15～20 s,其各分支动脉充盈时间3～8 s为有效;A-Rct虽较治疗前缩短但仍≥21s,其各分支动脉充盈时间≥9 s为无效.分析年龄、性别、病程以及后续治疗时间与疗效的关系.结果 尿激酶静脉内溶栓治疗后FFA复查的79例患者中,11例治疗前为完全阻塞,溶栓治疗后其中8只眼显示视盘表面的血管逆行充盈消失,A-Rct 28～54 s,视网膜动脉主干末梢充盈时间18～55 s;3只眼造影3～4 min内仍显示视盘表面的血管逆行充盈.68例不完全阻塞者A Rct恢复正常35例,占51.5％;有效18例,占26.5％;无效15例,占22.0％;溶栓治疗后视网膜循环时间短于治疗前,差异有统计学意义(x2 =11.4,P＜0.05).尿激酶静脉内溶栓治疗前后视力分布比较,差异有统计学意义(x2＝12.1,P＜0.05).后续治疗后最终视力与尿激酶静脉内溶栓治疗后视力分布比较,差异有统计学意义(x2＝14.6,P＜0.05);其中,48只眼视力提高2行甚至2行以上,占41.7％.后续治疗后最终视力与治疗前视力分布比较,差异有统计学意义(x2 =44.5,P＜0.05).其中,视力改变为显效者58只眼,占 50.4％;有效者35只眼,占30.4％;无效者22只眼,占19.2％.不同年龄段患者有效率比较,差异无统计学意义(x2=4.8,P＞0.05).男性患者与女性患者有效率比较,差异无统计学意义(x2 ＝2.6,P＞0.05).病程7d内者76例,显效者43例,有效者22例,有效率85.5％;病程8～15 d者25例,显效者11例,有效者8例,有效率76.0％;病程超过15d者14例,显效者4例,有效者5例,有效率64.3％.后续治疗7d者30例,显效13例,有效8例,有效率70.0％;后续治疗8～14 d者34例,显效18例,有效9例,有效率79.4％;后续治疗15～21 d者51例,显效27例,有效者18例,有效率88.2％.结论 以尿激酶静脉溶栓为主的治疗方法可有效治疗CRAO.

abstractsObjective To observe the effects of intravenous thrombolysis with urokinase for centralretinal artery occlusion (CRAO).Methods A total of 115 CRAO patients diagnosed by fluorescence fundus angiography (FFA) were enrolled in this study.The patients included 61 males and 54 females,with a mean age of (56.7±15.2) years (from 41 to 75 years).The duration ranged from 1 to 30 days.All the patients were affected unilaterally.All the patients were received the treatment of intravenous thrombolysis with urokinase (3000 U/kg,two times per day,continuous treatment for six to seven days) and retrobulbar injection of dexamethasonc 2.5 mg (one time per day,continuous treatment for 14 days).Following that,1.2 mg/kg brain protein hydrolysate (nerve nutrition) and 360 mg troxerutin (vasodilator) were given by intravenous drip (one time per day,continuous treatment for 14 days).Effectiveness of the thrombolytic and subsequent treatments including the recovery of vision and retinal arterial filling time before and after treatment were observed.Comparing the visual acuity of post treatment and pre-treatment,improving three lines or more is considered as effective markedly,improving two lines as effective,no change or a decline as no effect.With FFA as the retinal circulation recovery index,the arm-retinal circulation time (A-Rct) ≤ 15s and all branches of central retinal artery were filled with fluorescence within 2s filling (normal) as effective markedly; A-Rct improved but was in 15～20s range,all branches of central retinal artery were filled with fluorescence within 3～ 8s as effective; A Rct improved but was still ≥ 21s,all branches of central retinal artery were filled with fluorescence within ≥9s as no effect.The relationship between age,gender,the disease course,subsequent treat time and curative effectiveness were analyzed.Results There were 79 patients were examined for FFA again after thromholysis treatment which including 11 patients with complete obstruction and 68 patients with incomplete obstruction.In 11 patients with complete obstruction,eight patients showed that optic disc vascular retrograde filling disappeared,A Rct was 28-54s,and the filling time from retinal artery to tip was18-55s; three patients showed persistent optic disc vascular retrograde filling within 3-4 minutes of FFA.In 68 patients with incomplete obstruction,A-Ret returned to normal in 35 patients (51.4％),effective in 18 patients (26.5％) and no effect in 15 patients (22.1％).Retinal circulation time was shorter than that before thrombolysis treatment (x2 =11.4,P＜0.05).Comparison of distribution of visual acuity before and after thrombolysis treatment,the difference was statistically significant (x2=12.1,P＜0.05).Comparison of distribution of final visual acuity after subsequent treatment with that of after thrombolysis treatment,48 eyes improved two lines or more,the efficiency was 41.7％,the difference was statistically significant (x2 =14.6,P＜0.05).Comparison to that of before treatment,vision changes showed effect markedly in 58 patients (50.4％),effective in 35 patients (30.4％),no effect in 22 patients (19.2％),the difference was statistically significant (x2 =44.5,P＜0.05).Comparison the average age to that of effective,valid and invalid patients,the difference was not statistically significant (t=0.98,1.17,0.55; P＞0.05).There was no relationship between effectiveness and gender (x2=2.6,P＞0.05).In 76 patients with duration within seven days,43 patients were effective markedly and 22 patients were effective,the efficiency was 85.5％.In 25 patients with duration of 8-15 days,11 patients were effective markedly and eight patients were effective,the efficiency was 76.0％.In 34 patients who received subsequent treatment 8-14 days,18 patients were effective markedly and nine patients were effective,the efficiency was 79.4％.In 51 patients who received subsequent treatment 15-21 days,27 patients were effective markedly and 18 patients were effective,the efficiency was 88.2％.Conclusion Intravenous thrombolysis with urokinase was effective in the treatment of CRAO.