经颈内动脉灌注溶栓药治疗实验性视网膜中央动脉阻塞

Thrombolytic drug infusion via carotid artery treating experimental central retinal artery occlusion

目的 观察经颈内动脉灌注溶栓药治疗实验性视网膜中央动脉阻塞 (CRAO)的效果及对全身的影响。 方法 对 15只猫 30只眼静脉注射光化学药物后激光照射猫视网膜动脉形成 CRAO模型 ,随机分为 3组 :颈内动脉给药组、静脉给药组及空白对照组 ,每组 5只猫 10只眼 ,分别经颈内动脉、股静脉给予尿激酶 (UK)溶栓 ,空白对照组仅静脉给予等渗盐液。通过荧光素眼底血管造影判断动脉再通情况 ,同时作血液生化指标检查以观察其对全身的影响。 结果 用药 4 h后 ,经颈内动脉灌注组 5只猫 8只眼动脉完全再通 ,占 80 % ;静脉组 4只猫 5只眼完全再通 ,占 5 0 % ,两组比较差异有显著性的意义 (R值的 95 %可信区间无重叠 ,相差显著 )。用药后 ,颈内动脉给药组血液中的凝血、纤溶、抗纤溶等指标均优于静脉给药组和空白对照组 (P值均 <0 .0 1)。 结论 在用 UK溶栓治疗实验性 CRAO中 ,颈内动脉给药比静脉给药更安全有效 ,这为临床治疗 CRAO提供了新的给药途径和动物实验资料。

Objective To investigate the therapeutic effects of thrombolytic drug infusion via carotid artery on experimental central retinal artery occlusion (CRAO), and observe the changes of fibrinolytic activity in the systemic circulation. Methods To dissolve the thrombi in 15 cats (30 eyes) with CRAO established by laser irradiating a branch of central retinal artery after intravenous injection of photochemical drugs, urokinase (UK) was directly infused via carotid artery in 5 cats (10 eyes) in group A or intravenously injected in 5 cats (10 eyes) in group B, and isotonic saline solution was intravenously injected in 5 cats (10 eyes) in group C respectively. The patency of the artery was evaluated by fundus fluorescein angiography. Moreover, the changes of fibrinolitic activity in the blood were observed by blood biochemical examination. Results Four hours after UK infusion, the complete repatency proportion was 80% (5 cats 8 eys) in group A, and 50% (4 cats 5 eyes) in group B. There was significant difference between the two groups. Besides, after the infusion, the indexes of coagulation, fibrinolysis, and anti-fibrinolysis in group A were better than those in group B and C (P<0.01). Conclusion In the treatment of experimental CRAO, thrombolytic drug infusion via carotid artery is better and more effective than via intravenous injection, which may provide a new method of thrombolytic drug delivery and animal models.