本文選題：視網(wǎng)膜中央動脈阻塞 + 超選眼動脈��； 參考：《山西醫(yī)科大學》2010年碩士論文

【摘要】： 目的視網(wǎng)膜中央動脈阻塞是眼科的急癥之一,發(fā)病急驟,預測性差,可造成視網(wǎng)膜急性缺血缺氧,導致視力嚴重下降,甚至失明,是嚴重危害視力的疾病之一,致殘率很高。與靜脈給藥相比,動脈內(nèi)灌注溶栓視網(wǎng)膜可獲得的藥物濃度是后者的117倍,可以達到快速、有效、準確地治療效果。在評價超選眼動脈和頸內(nèi)動脈介入溶栓治療視網(wǎng)膜中央動脈阻塞的同時,對其療效進行對比研究,試圖用經(jīng)濟、安全、方便的頸內(nèi)動脈溶栓代替復雜、昂貴的超選眼動脈溶栓。資料與方法回顧性分析30例經(jīng)眼底鏡及熒光素眼底血管造影(FFA)診斷為CRAO的患者,包括性別、年齡、病因、臨床癥狀、治療方法、療效及并發(fā)癥。將其隨機分成兩組,頸內(nèi)動脈17例,超選眼動脈13例。經(jīng)股動脈插管,應用Selding技術,將導管插入頸內(nèi)動脈虹吸部或超選眼動脈,分別灌注60-70萬IU或20-30萬IU尿激酶溶栓治療,并于治療前、后分別行FFA檢查和視力測試,觀察其動脈顯影的時間和視力的變化,采用病例對照研究的方法,將其結果進行統(tǒng)計學分析。結果溶栓治療前、后,頸內(nèi)動脈治療組動脈顯影時間分別為41.6±12.7(12-62)s、13.9±4.4(6-20)s,P0.05,超選眼動脈治療組分別為45.2±19.2(20-64s)、14±3.3(10-21s),P0.05,兩者之間的差別均有統(tǒng)計學意義。溶栓治療后,頸內(nèi)動脈溶栓治療組視力改善率為76.4%,超選眼動脈溶栓治療組改善率為84.6%,P=0.573180.05；頸內(nèi)動脈治療組溶栓前、后FFA動脈顯影的時間差為27.7±18.8s(4-54s)；超選眼動脈治療組為31.2±18.3s(8-51s),P0.05,兩者之間的差異均無統(tǒng)計學意義。術后1例患者發(fā)生顱內(nèi)出血、1例發(fā)生下肢活動受限、2例發(fā)生玻璃體出血結論頸內(nèi)動脈和超選眼動脈兩種插管方式治療急性視網(wǎng)膜中央動脈阻塞均可取得顯著療效,但是,在嚴格篩選病例、準確把握手術指征的情況下可以用安全、經(jīng)濟、有效的頸內(nèi)動脈插管溶栓代替復雜、昂貴的超選眼動脈溶栓。
[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 鹵12.7g / 12 ~ (12) ~ (2) C ~ (-1) ~ (13. 9 鹵4. 4) ~ (6) -20 ~ (-1) P _ (0.05), respectively, and that in the overselective ophthalmic artery group was 45.2 鹵19.22 ~ 20 ~ (64) s ~ (-1) 14 鹵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 鹵18.8sL 4-54sL, and that of OCA group was 31.2 鹵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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R774.1

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本文編號：1995957