摘要目的:观察不同时间窗尿激酶动脉溶栓治疗视网膜中央动脉阻塞（CRAO）的有效性和安全性。方法:回顾性研究。2014年1月至2019年11月在西安市人民医院（西安市第四医院）眼科住院治疗的CRAO患者157例157只眼纳入研究。其中，男性120例，女性37例；平均年龄（54.87±12.12）岁，平均发病时间（65.66±67.44）h。所有患者采用国际标准视力表检测BCVA，并将结果转换为logMAR视力记录。采用FFA测量患眼臂-视网膜循环时间（A-Rct ）及视网膜动脉主干-末梢充盈时间（FT ）。患眼平均logMAR BCVA为2.44±0.46，平均A-Rct、FT分别为（27.72±9.78）、（13.58±14.92）s。根据发病时间将患者分为发病3~72 h组、发病73~240 h组，分别为115例和42例。两组患者年龄、A-Rct及logMAR BCVA比较，差异均无统计学意义（ χ2=-0.197、-1.242、-8.990， P=0.844、0.369、0.369）；FT比较，差异有统计学意义（ x2=-3.652 ， P=0.000 ）。发病后3~24 h、25~72 h、73~96 h、97~120 h、121~240 h进行尿激酶动脉溶栓治疗，不同治疗时间窗患者的年龄、A-Rct比较，差异无统计学意义（ χ2=6.588、6.679， P=0.253、0.246）；FT、logMAR BCVA比较，差异有统计学意义（ χ2=30.150、71.378， P=0.000、0.000 ）。治疗后24 h复查FFA，治疗后30 d复查视力。对比分析患眼治疗前后A-Rct、FT及BCVA的变化情况。观察患者治疗中及治疗后不良反应的发生情况。两组计量资料均数比较，符合正态分布者采用 t检验，非正态分布者采用 χ 2检验。发病时间与治疗后A-Rct、FT缩短时间及logMAR BCVA差值的相关性采用Spearman相关性分析。 结果:治疗后24 h ，患眼A-Rct、FT分别为（19.64±6.50）、（6.48±7.36）s，均较治疗前明显缩短，差异有统计学意义（ χ2=-16.236、-14.703， P=0.000、0.000 ）。治疗后30 d，患眼logMAR BCVA为1.72±0.76，较治疗前明显提高，差异有统计学意义（ χ2=-14.460， P=0.000 ）。不同治疗时间窗的患眼治疗前后A-Rct、FT缩短时间和logMAR BCVA差值比较，差异有统计学意义（ χ2=12.408、24.200、104.388， P=0.030、0.000、0.000 ）。发病3~72 h组和发病73~240 h组患眼治疗后A-Rct缩短时间比较，差异无统计学意义（ χ2=-1.042， P=0.297）；FT缩短时间比较，差异有统计学意义（ χ2=-3.581， P=0.000）；logMAR BCVA差值比较，差异有统计学意义（ χ2=-9.905 ， P=0.000）。Spearman相关性分析结果显示，发病时间与治疗后A-Rct、FT缩短时间均无相关性（ rp=-0.040、-0.081， P=0.436、0.115 ），与logMAR BCVA差值呈负相关（ rp=-0.486， P=0.000 ）。治疗后发生颅内出血1例，经脱水减轻脑水肿、清除自由基以及脑保护等治疗后好转。 结论:尿激酶动脉溶栓治疗发病3~240 h内的CRAO有效，A-Rct、FT均缩短，视力提高；但随着溶栓治疗时间窗的延长治疗效果降低，72 h内尿激酶动脉溶栓治疗效果较好。

abstractsObjective:To observe the efficacy and safety of urokinase arterial thrombolysis in the treatment of central retinal artery occlusion (CRAO) at different time window.Methods:A retrospective study. From January 2014 to November 2019, 157 eyes (157 CRAO patients) in the Xi’an People's Hospital (Xi’an Fourth Hospital) were included in the study. There were 120 males and 37 females, with the average age of 54.87±12.12 years. The mean onset time was 65.66±67.44 h. All patients were tested with BCVA using international standard visual acuity chart, and the results were converted into logMAR visual acuity record. The arm-retinal circulation time (A-Rct) and the filling time (FT) of retinal arterial trunk-terminal filling time were measured by FFA. The mean logMAR BCVA was 2.44±0.46, the mean A-Rct and FT were 27.72±9.78 and 13.58±14.92 s respectively. According to the time window, the patients were divided into the onset 3-72 h group and the onset 73-240 h group, which were 115 patients and 42 patients respectively. There were no statistically significant difference between the 3-72 h group and the 73-240 h group in age, A-Rct and LogMR BCVA before treatment ( χ2=-0.197, -1.242, -8.990; P=0.844, 0.369, 0.369); the difference was statistically significant in FT comparison ( χ2=-3.652, P=0.000). Urokinase artery thrombolytic therapy was performed at different time window of 3-24 h, 25-72 h, 73-96 h, 97-120 h, 121-240 h after the onset of onset. Age and A-Rct of patients with different treatment time windows were compared, and the differences were not statistically significant ( χ2=6.588, 6.679; P=0.253, 0.246).In comparison of FT and logMAR BCVA, the difference was statistically significant ( χ2 =30.150, 71.378; P=0.000, 0.000). FFA was rechecked 24 hours after treatment, BCVA was rechecked 30 days after treatment. The changes of A-Rct, FT and BCVA before and after treatment were compared and analyzed. The occurrence of adverse reactions during and after treatment were observed. The two groups of measurement data were compared. The t test was used for those with normal distribution and χ2 test was used for those with non-normal distribution. Spearman correlation analysis was used to analyze the correlation between onset time and the difference of A-Rct, FT shortening time and logMAR BCVA after treatment. Results:At 24 h after CRAO treatment, A-Rct and FT of 157 cases were 19.64±6.50 and 6.48±7.36 s respectively, which were significantly shorter than those before treatment, and the differences were statistically significant ( χ2=-16.236, -14.703; P=0.000, 0.000). The logMAR BCVA at 30 d after treatment was 1.72±0.76, which was significantly higher than that before treatment. The difference was statistically significant ( χ2=-14.460, P=0.000). After CRAO urokinase arterial thrombolysis at different time window, there were statistically significant differences in A-Rct shortening time, FT shortening time, and logMAR BCVA difference ( χ2=12.408, 24.200, 104.388; P=0.030, 0.000, 0.000). There was no statistically significant difference between the 3-72 h group and the 73-240 h group ( χ2 =-1.042, P=0.297) in shortening time of A-Rct after treatment. The difference of FT shortening time was statistically significant ( χ2=-3.581, P=0.000). The difference of logMAR BCVA was statistically significant ( χ2=-9.905, P=0.000). The results of Spearman correlation analysis showed that there was no correlation between the onset time and the shortening time of A-Rct and FT after treatment ( rp=-0.040, -0.081; P=0.436, 0.115), and negative correlation with the logMAR BCVA difference ( rp=-0.486, P=0.000). One case of intracranial hemorrhage occurred after treatment, and it improved after dehydration to reduce cerebral edema, scavenging free radicals and brain protection. Conclusions:Urokinase arterial thrombolytic therapy is effective for CRAO within time window of 3-240 h, A-Rct, FT and LogMRA BCVA are all improved. However, with the prolongation of thrombolytic therapy time window, the therapeutic effect of urokinase arterial thrombolytic therapy is decreased. The therapeutic effect of Urokinase arterial thrombolytic therapy was better within 72 h.