银杏达莫注射液治疗视网膜动脉阻塞的疗效分析

Effects of Xingding Ginkgo-Dipyridamolum Injection in Treatment of Retinal Artery Occlusion

目的:观察银杏达莫注射液治疗视网膜动脉阻塞(RAO)的疗效。方法:58例(58只眼)视网膜动脉阻塞患者纳入本研究。视网膜分支动脉阻塞(BRAO)18例,其中2例伴有视网膜分支静脉阻塞(BRAO伴BRVO),2例伴有视网膜中央静脉阻塞(BRAO伴CRVO);视网膜中央动脉阻塞(CRAO)40例,其中7例伴有视网膜中央静脉阻塞(CRAO伴CRVO)。男32例,女26例,年龄36~86岁,平均(62.12±13.79)岁。所有患者均单眼发病,病程4 h^20 d,平均(5.13±5.05)d。视力LP^1.0,平均(0.17±0.30)。所有患者均给予银杏达莫注射液20 m L加5%葡萄糖注射液(或9%生理盐水)250 m L静脉滴注,每天2次,疗程3 d^6周,平均(2.24±1.18)周。同时给予舌下含服硝酸甘油片,口服阿司匹林扩血管、弥可保营养神经以及配合局部按压眼球等治疗,随访时间1周~6周。通过视力、眼底彩照、光学相干断层扫描(OCT)及荧光素眼底血管造影(FFA)等检查观察视功能变化及视网膜水肿、黄斑体积以及视网膜动脉再通情况。结果:除了2例2只CRAO伴CRVO患眼在治疗后1周眼底灰白色水肿加重以外,所有患眼在治疗后不同时间随访,阻塞部位灰白色水肿均有不同程度的消退,樱桃红斑逐渐消失。治疗后1周、2周、3周与治疗前平均视力相比,均明显提高,差异均有统计学意义。OCT显示治疗后平均中心凹视网膜厚度(CRT)和平均黄斑体积(CMV)与治疗前相比,在治疗后1周差异无统计学意义;治疗后2周、3周与治疗前相比明显降低,差异均有统计学意义P<0.05。17只患眼在治疗后复查了FFA,其中10只患眼在治疗后1周复查FFA,除了1只患眼无明显改善外,其他9只患眼均显示A-RCT时间缩短,视网膜动-静脉循环时间臂-视网膜循环时间(A-RCT)缩短,视网膜血管充盈好转。6只患眼在治疗后2周、1只患眼在治疗后3周复查FA,上述情况均明显好转。结论:银杏达莫注射液能扩张血管,改善视网膜循环,改善视功能,治疗视网膜动脉阻塞效果良好,且长期使用无明显眼部及全身不良反应。

Objective： To investigate the effects of Xingding Ginkgo- Dipyridamolum Injection on the treatment of retinal artery occlusion. Methods： 58 eyes of 58 patients diagnosed as retinal artery occlusion were included in this study. 18 eyes of 18 patients were branch retinal artery occlusion（ BRAO）,among which there were 2 patients complicated branch retinal vein occlusion（ BRAOBRVO） and 2 patients complicated central retinal vein occlusion（ BRAOCRVO）. 40 eyes of 40 patients were central retinal artery occlusion（ CRAO）,among which there were 7 patients complicated central retinal vein occlusion（ CRAOCRVO）. The patients（ 32 males and 26 females） aged from 36 to 86 years old with the average age of（ 62. 12 ± 13. 79）. The course of disease was ranging from 4 hours to 20 days with the average of（ 5. 13 ± 5. 05） days.The visual acuity was ranging from light perception（ LP） to 1. 0 with the average of（ 0. 17 ± 0. 30）. All patients were given20 mL Xingding Ginkgo- Dipyridamolum with 250 mL 5 % Dextrose Injection（ or 0. 9% Sodium Chloride Injection） intravenous infusion once a day for 3 days to 6 weeks,with a average of（ 2. 24 ± 1. 18） weeks,combined with sublingual nitroglycerin,aspirin,methycobal and ocular massage. The visual acuity,colour funds photography,optical coherence tomography（ OCT） and fundus fluorescein angiography（ FFA） were performed during the follow up within 1 to 6 weeks. Results： In most cases,the retinal opacification faded and cherry- red spot gradually disappeared during their follow- up,except two cases got worse. The mean BCVA was significantly improved at 1 week,2 and 3 weeks after treatment. The mean central macular thickness decreased at 2,3 weeks after treatment and statistical difference was found compared with pretreatmentduring the follow- up period（ P 0. 05）. 17 cases received FFA evaluation after treatment,10 at 1 week,6 at 2 weeks,1at 3 weeks post- treatment,16 of 17 cases showed shorter A- RCT and improved retinal circulation,only 1 case showed no difference. Conclusions： Xingding Ginkgo- dipyridamolum Injection works as vasodilator,which can increase retinal blood supply and visual function,and is likely to be beneficial for the treatment of retinal artery occlusion. Besides,no significant ocular and systemic adverse reactions were found during 6 weeks follow- up me.