脑血栓的微导管溶栓治疗——附16例报告  

Thrombolysis with microcatheter in treating cerebral thrombosis: report of 16 cases

作　　者：魏崇建[1] 阎小纺[1] 乔英[1] 

机构地区：[1]广州军区武汉总医院放射科,湖北武汉430070

出　　处：《中国介入影像与治疗学》2007年第2期86-88,共3页Chinese Journal of Interventional Imaging and Therapy

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。方法本组16例患者,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。从发现症状到溶栓治疗时间:10min 1例,4 h 1例,6 h 7例,8 h 5例,22 h 2例。全组均经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%,三天后肌力从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 was in discussion so as to enhance the effects of thrombolysis. 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 h, 6 h, 8 h and 22 h later after the clinical symptoms were detected was the thrombolysis performed on 1 patient, 1 patient, 7 patients, 5 patients, 2 patients respectively on the basis of the demonstration of accurate position of the thrombosis through CT scan and selective angiography via femoral artery. The maximum dose of urokinase involved was 600 000 U, while the minimum was 350 000 U. 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 occurred in 2 cases, whose mascalar strength reached up to level 11 compared with the previous level 0. 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 died of respiratory failure. Condusion The earlier the thrombolysis is performed, the better the effect is. Furthermore, thrombolysis will make urokinase thoroughly contact thrombosis, which may shorten the time span of thrombolysis and reduce significantly the use of urkinase.

关 键 词：血栓 微导管 动脉内溶栓 尿激酶 

分 类 号：R743.3[医药卫生—神经病学与精神病学]