超选眼动脉和颈内动脉溶栓治疗急性CRAO的对比研究

发布时间：2018-06-08 13:31

本文选题：视网膜中央动脉阻塞 + 超选眼动脉　；参考：《山西医科大学》2010年硕士论文

【摘要】： 目的视网膜中央动脉阻塞是眼科的急症之一,发病急骤,预测性差,可造成视网膜急性缺血缺氧,导致视力严重下降,甚至失明,是严重危害视力的疾病之一,致残率很高。与静脉给药相比,动脉内灌注溶栓视网膜可获得的药物浓度是后者的117倍,可以达到快速、有效、准确地治疗效果。在评价超选眼动脉和颈内动脉介入溶栓治疗视网膜中央动脉阻塞的同时,对其疗效进行对比研究,试图用经济、安全、方便的颈内动脉溶栓代替复杂、昂贵的超选眼动脉溶栓。资料与方法回顾性分析30例经眼底镜及荧光素眼底血管造影(FFA)诊断为CRAO的患者,包括性别、年龄、病因、临床症状、治疗方法、疗效及并发症。将其随机分成两组,颈内动脉17例,超选眼动脉13例。经股动脉插管,应用Selding技术,将导管插入颈内动脉虹吸部或超选眼动脉,分别灌注60-70万IU或20-30万IU尿激酶溶栓治疗,并于治疗前、后分别行FFA检查和视力测试,观察其动脉显影的时间和视力的变化,采用病例对照研究的方法,将其结果进行统计学分析。结果溶栓治疗前、后,颈内动脉治疗组动脉显影时间分别为41.6±12.7(12-62)s、13.9±4.4(6-20)s,P0.05,超选眼动脉治疗组分别为45.2±19.2(20-64s)、14±3.3(10-21s),P0.05,两者之间的差别均有统计学意义。溶栓治疗后,颈内动脉溶栓治疗组视力改善率为76.4%,超选眼动脉溶栓治疗组改善率为84.6%,P=0.573180.05；颈内动脉治疗组溶栓前、后FFA动脉显影的时间差为27.7±18.8s(4-54s)；超选眼动脉治疗组为31.2±18.3s(8-51s),P0.05,两者之间的差异均无统计学意义。术后1例患者发生颅内出血、1例发生下肢活动受限、2例发生玻璃体出血结论颈内动脉和超选眼动脉两种插管方式治疗急性视网膜中央动脉阻塞均可取得显著疗效,但是,在严格筛选病例、准确把握手术指征的情况下可以用安全、经济、有效的颈内动脉插管溶栓代替复杂、昂贵的超选眼动脉溶栓。
[Abstract]:Objective Central retinal artery occlusion is one of the urgent diseases in ophthalmology. It can cause acute ischemia and anoxia of the retina, leading to serious loss of vision, even blindness, and it is one of the diseases that seriously harm visual acuity. The rate of disability is very high. Compared with intravenous administration, the intraarterial thrombolytic retinal concentration was 117 times higher than that of the latter, and the therapeutic effect was rapid, effective and accurate. In order to evaluate the therapeutic effect of interventional thrombolytic therapy for central retinal artery occlusion, the economic, safe and convenient internal carotid artery thrombolysis was used to replace the complicated and expensive superselective ophthalmic artery thrombolytic therapy. Materials and methods 30 cases of CRAO diagnosed by fundus endoscopy and fundus fluorescein angiography (FFAA) were retrospectively analyzed, including sex, age, etiology, clinical symptoms, treatment methods, curative effects and complications. They were randomly divided into two groups: 17 cases of internal carotid artery and 13 cases of superselective ophthalmic artery. The catheter was inserted into the siphon part of the internal carotid artery or superselective ophthalmic artery by femoral artery intubation. The thrombolytic therapy was performed with 60-700 IU or 20-300 IU urokinase respectively. FFA examination and visual acuity test were performed before and after treatment. The time and visual acuity of arteriography were observed and the results were statistically analyzed by case-control study. Results before and after thrombolytic therapy, the contrast time of carotid artery in the internal carotid artery treatment group was 41.6 卤12.7g / 12 ~ (12) ~ (2) C ~ (-1) ~ (13. 9 卤4. 4) ~ (6) -20 ~ (-1) P _ (0.05), respectively, and that in the overselective ophthalmic artery group was 45.2 卤19.22 ~ 20 ~ (64) s ~ (-1) 14 卤3.310 ~ (-21) s P0.05, respectively. There was significant difference between the two groups. After thrombolytic therapy, the improvement rate of visual acuity in the internal carotid artery thrombolytic treatment group was 76.4 and that in the superselective ophthalmic artery thrombolytic treatment group was 84.6p 0.573180.05.The improvement rate was 0.573180.05in the internal carotid artery group before thrombolytic therapy. The time difference of posterior FFA arteriography was 27.7 卤18.8sL 4-54sL, and that of OCA group was 31.2 卤18.3sL 8-51sP0.05.The difference between the two groups was not statistically significant. Intracranial hemorrhage occurred in one patient after operation. One patient with lower extremity movement limitation and two with vitreous hemorrhage. Conclusion both internal carotid artery and overselective ophthalmic artery can be used in the treatment of acute central retinal artery occlusion. Safe, economical and effective internal carotid artery catheterization can be used to replace complicated and expensive super-selective ophthalmic artery thrombolytic therapy in the case of strict screening of cases and accurate indication of operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

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