高压氧综合治疗对视网膜中央动脉阻塞患者的临床疗效观察

Observation on the clinical efficacy of comprehensive hyperbaric oxygen on the patients with central retinal artery occlusion

目的探讨高压氧(HBO)综合治疗对视网膜中央动脉阻塞(CRAO)患者的临床疗效及其作用机制。方法将宁夏回族自治区人民医院2017年1月至2019年1月收治的的视网膜中央动脉阻塞患者137例分成对照组和观察组。对照组66例,采用常规疗法治疗;观察组71例,在常规疗法的基础上采用HBO治疗。在治疗2个疗程后,采用国际标准对数视力表对患者视力恢复情况进行检测,统计2组患者的治疗总有效率。治疗前后对2组患者进行眼底荧光血管造影,检测并统计患者臂-视网膜动脉显影时间(A-Rct),同时检测2组患者血浆纤维蛋白原含量以及血浆黏度;比较治疗后2组患者静脉阻塞点位置(VOP)和动脉压迫状态(AP)好转率。结果治疗2个疗程后,观察组患者总有效率(71.7%)明显高于对照组(50.7%)(P<0.05);观察组视力提高至0.1以上的患者例数显著增加,且视力在0.5~0.9的患者例数显著多于对照组(均P<0.05);2组患者A-Rct时间相较于治疗前均显著缩短(P<0.01),但2组患者治疗后A-Rct时间比较差异无统计学意义(P>0.05);2组患者纤维蛋白原、血浆黏度与治疗前比较显著下调,且观察组治疗后明显低于对照组(均P<0.05)。观察组患者VOP好转率(45.45%)明显高于对照组(18.18%);观察组患者AP有效率(21.13%)明显高于对照组(4.23%)(P<0.01)。结论HBO综合治疗可显著提高CRAO患者的临床疗效,值得临床推广应用。

Objective To investigate the clinical efficacy of comprehensive hyperbaric oxygen(HBO)on the patients with central retinal artery occlusion and possible mechanism involved.Methods A total of 137 patients with central retinal artery occlusion admitted into our hospital from January 2017 to January 2019 were divided into the control group(66)and the observation group(71).The control group was treated with conventional therapy,while the observation group received HBO on the basis of conventional therapy.After 2 courses of treatment,the visual acuity recovery of the patients was detected using the International Standard Logarithmic Visual Acuity Table,and then total therapeutic rates of the 2 groups were statistically analyzed.Fundus fluorescein angiography was performed before and after treatment in the patients of both groups,and development time of the patients′arm-retinal artery(A-Rct)was detected and statistically analyzed.At the same time,plasma fibrinogen content and plasma viscosity of the patients in the 2 groups were also detected.Then,venous occlusion position(VOP)and arterial pressure(AP)status were compared between the patients of the 2 groups.Results After 2 courses of treatment,total efficacy of the observation group was 71.7%,which was obviously higher than that of the control group(50.7%)(P<0.05).In the observation group,the number of patients whose visual acuity increased to over 0.1 was significantly higher than that of the control group,and the number of patients with a visual acuity of 0.5-0.9 in the observation group was obviously higher than that of the control group(all P<0.05).As compared with that before treatment,the arm-retinal arterial time(A-Rct)of both groups were significantly shortened after treatment(P<0.01),however,there were no significant differences in A-Rct after treatment,when comparisons were made between the 2 groups(P>0.05).In addition,the expression levels of plasma fibrinogen and plasma viscosity were obviously down-regulated as compared with those before treatment,with those of the observation group after treatment being obviously lower than those of the control group(all P<0.05).The improvement rate of VOP for the patients of the observation group was 45.45%,which was obviously higher than that of the control group(18.18%).The effective rate of AP for the patients of the observation group was 21.13%,which was significantly higher than that of the control group(4.23%),also with statistical significance(P<0.05).Conclusion Comprehensive HBO therapy could significantly enhance clinical efficacy of the patients with central retinal artery occlusion and it was worth further clinical promotion.