超声下凝血酶注射治疗假性动脉瘤  

Ultrasound guided thrombin injection for treatment of iatrogenic pseudoaneurysms

作　　者：晋军[1] 黄岚[1] 覃军[1] 宋耀明[1] 李爱民[1] 耿召华[1] 周小波[1] 于学军[1] 林春梅[1] 高云华[2] 卓忠雄[3] 

机构地区：[1]第三军医大学新桥医院全军心血管内科中心,重庆400037 [2]第三军医大学新桥医院第三军医大学新桥医院超声诊断室,重庆400037 [3]第三军医大学新桥医院超声诊断室,重庆400037

出　　处：《重庆医学》2007年第12期1171-1172,1176,共3页Chongqing medicine

摘　　要：目的 经皮超声引导下注射凝血酶（UGTI）治疗股动脉假性动脉瘤（PS）的方法学探讨及可行性评价。方法 15例经股动脉径路选择性冠脉造影和冠脉介入术后医源性股动脉PS患者接受了UGTI治疗。男5例，女10例，平均（68．5±12）岁，选择性冠脉造影1例，经皮冠脉介入14例。单腔的单纯型PS9例，2腔或3腔的复杂型PS6例。局麻后在超声引导下准确定位注射器针头，单纯PS尽可能在瘤腔底部，远离瘤颈部，复杂PS首选在远端瘤腔的底部，注射凝血酶速度宜慢，剂量为100-800IU凝血酶，超声下观察瘤腔内血栓形成，UGTI后24h、5～7d接受二维超声随访。结果 PS平均容积为（13±4．89）cm^3。共注射凝血酶21次，单腔注射凝血酶剂量为（250±120）IU，双腔或多腔为（650±150）IU。9例单腔患者全部一次成功；6例双腔或多腔的复杂PS患者4例首次成功，1例24hr出现“再通”，1例15d出现“再通”，经重复3次注射凝血酶后，封闭成功。无1例出现血栓形成、感染、过敏等并发症。结论 掌握正确的UGTI操作方法是治疗股动脉PS成功的前提条件，也是减少操作并发症的重要因素。采用正确的UGTI方法可作为医源性股动脉PS的首选治疗。Objective To explore the methodology and feasibility of ultrasound guided thrombin injection（UGTI） for the treatment of iatrogenic pseudoaneurysms. Methods Fifteen iatrogenic pseudoaneurysms patients following femoral arterial puncture for coronary arterial angiography and PCI were treated with UGTI. One coronary arterial angiography and 14 PCI were performed in 5 males and 10 females（mean age 68.5±12 ）. Nine simple PS with one lobe and 6 complex PS with two or three lobes. Under local anesthesia thrombin jection（100-800IU） was performed slowly into basal part in simple PS and distal lobe in complex PS with US- guidance. Duplex sonographic follow-up examination were performed at 24h and 5-7d. Results Mean volume of PS was （13± 4.89）cm^3. Twenty-one thrombin injections were performed. Mean thrombin dose was （250±120）IU in simple and 650IU± 150 in complex PS. Reperfusion occurred in one complex PS after 24h of UGTI and another complex PS reperfusion was detected after 15d of UGTI, PS were completely obliterated after 3 times of thrombin injections. No thromhoembolic, infectious, allergic complications occurred. Conclusion Correctly operation is one of premise factors on UGTI, and it is an important factor in complication of procedure. UGTI can be as first-line therapy of iatrogenic pseudoaneurysms following femoral arterial puncture for PCI.

关 键 词：假性动脉瘤 凝血酶 方法 治疗 

分 类 号：R543[医药卫生—心血管疾病]