应用大剂量尿激酶治疗急性视网膜中央动脉阻塞的初步研究

探索大剂量尿激酶治疗视网膜中央动脉阻塞(CRAO)的有效性和安全性。6例单眼患有CRAO的病人,阻塞时间为6h一6天(平均3．7天),静脉滴注尿激酶每天50万U,总量250万U,治疗还包括前房穿刺、眼球按摩、口服醋氯酰胺、舌下含服硝酸异山梨酯和吸入95％O2和5％C02混合气体及每天静脉滴注低分子右旋糖苷500ml和金纳多87．5mg。治疗前后检查眼底和视力。随访时间为4—12个月。第一次用药后检查视力：除1例视力没有变化外,其余5例视力出现不同程度的改善。出院时所有病人视力均有提高,并且达到或好于0．05,3例大于0．1,2例达到1．0。最后随访视力：6例大于0．1,4例大于0．2,2例视力恢复到发病前最好视力1．2和1．5。治疗期间末发现严重并发症。结果显示,大剂量尿激酶连续静脉滴注治疗CRAO能够重新建立视网膜血液循环和提高视力。

A PRELIMINARY STUDY OF SYSTEMIC TREATMENT FOR ACUTE CENTRAL RETINAL ARTERY OCCLUSION WITH HIGH-DOSE UROKINASE

To investigate the effectiveness and safety of systemic administration of high dose urokinase for acute central retinal artery occlusion (CRAO). 6 patients who had unilateral CRAO with symptoms lasting 6 hours to six days' (average, 3 7 days) received intravenous urokinase, 500,000U / day, with a total dose of 2,500,000U. Each urokinase delivery was followed by in travenous low molecular weight Dextran, 500ml / day, and Ginaton 87 5 mg / day, for 10 days. The treatment also included anterior chamber paracentesis, ocular massage, oral acetazolamide, sublingual isosorbide dinitrate, and inhalation of carbogen ( 95% oxygen, 5% carbon dioxide ). Visual acuity and ocular findings were recorded before and after treatment. Duration of follow up ranged from 4 to 12 months. After first intravaneous urokinase, visual acuity was slightly improved in five of the 6 patients, and no change in one patient. All 6 patients showed markedly improved vision at discharge, with vision better than 0 05. At the final visit, visual acuity reached 0 1 in all the 6 patients, and in four patients visual acuity was improved to 0 2 or better, two patients had vision recovered even to 1 2 and 1 5, respectively. During treatment no serious complications were noticed. These results indicate that systemic treatment for acute central retinal artery occlusion with high dose urokinase could help reestablish retinal circulation and improve vision.