脑血栓的微导管溶栓治疗  

Treatment of Thrombolysis with Microcatheter in Cerebral Thrombosis

作　　者：魏崇建[1] 杨军发 阎小纺[1] 乔英[1] 

机构地区：[1]广州军区武汉总医院放射科,武汉430070

出　　处：《临床放射学杂志》2006年第1期66-68,共3页Journal of Clinical Radiology

摘　　要：目的探讨脑血栓用微导管溶栓治疗的时间、方法及后处理,以提高脑血栓治疗的疗效。资料与方法本组16例,其中颈内动脉血栓形成5例,大脑中动脉血栓形成8例,椎基底动脉血栓形成3例。从出现症状到溶栓治疗时间:10min1例,4h1例,6h7例,8h5例,22h2例。15例经CT证实无脑出血。行股动脉穿刺插管选择性动脉造影,明确血栓部位,将微导管超选择插入靶动脉内,采用接触+贯穿法溶栓。尿激酶用量最大者60万U,最小35万U。结果颈内动脉和大脑中动脉血栓形成13例,其中11例血栓完全溶解,肌力从0级升至Ⅳ级,肢体运动功能恢复,预后良好;2例血栓不全溶解,动脉造影复查显示靶动脉通畅70%,3d后肌力从0级升至Ⅱ级。3例椎基底动脉溶栓后造影显示2例血栓完全溶解,1例血管复通40%;3例中,1例预后良好,2例死于呼吸衰竭。结论(1)溶栓时间越早越好,如果能在超梗死期开始溶栓其预后是良好的。(2)接触+贯穿法溶栓,可加速血栓溶解,缩短脑细胞的缺血时间,提高溶栓效果,同时可明显减少尿激酶的用量。Objective The proper time, method and afterwards therapy of thrombolysis with microcatheter in treating thrombosis were discussed so as to enhance the effects of thrombolysis. Materials and Methods Of all 16 cases, internal carotid artery （ICA） thrombosis was found in 5 patients, middle cerebral artery （MCA） in 8, vertebral basilar artery （VBA） thrombosis in 3. 10 minutes, 4 hrs, 6 hrs, 8 hrs and 22 hrs later after the clinical symptoms were occurred to be treated with thrombolysis in 1 patient, 1 patient, 7 patients, 5 patients, 2 patients respectively, cerebral hemorrhage were not confirmed by CT in 15 cases, selective angiography via femoral artery were performed in each case.. The maximum dose of urokinase invoiced was 600000U, while the minimum was 350000U. Results In 13 cases with ICA and MCA thrombosis, the complete disappearance of thrombosis was found in 11 cases, whose limb function recovered and muscle strength was upgraded to level Ⅳ from level 0. 70% recanalization was occurred in 2 cases, whose mascular strength reached up to level Ⅱ compared with the previous level O 3 days later. In 3 cases with VBA thrombosis, the complete appearance of thrombosis was found in 2 cases and 40% recanalization in 1 case. Outcome was good in 1 case and 2 cases were died of respiratory failure. Conclusion The earlier the thrombolysis is performed, the better the effect is. Furthermore, thrombolysis with urokinase thoroughly contact thrombosis can shorten the time of cerebral ischemia, and reduce the usage of urkinase significantly.

关 键 词：脑梗死 动脉内溶栓 尿激酶 

分 类 号：R743[医药卫生—神经病学与精神病学]