儿童缺血性脑血管病颈内动脉溶栓治疗  

Internal carotid artery thrombolysis therapy for children with ischemic cerebrovascular disease

作　　者：刘帆[1] 秦增辉[1] 黄穗[1] 刘智胜[2] 胡家胜[2] 孙丹[2] 

机构地区：[1]武汉市儿童医院放射科,湖北武汉430016 [2]武汉市儿童医院神经内科,湖北武汉430016

出　　处：《临床儿科杂志》2009年第2期156-158,共3页Journal of Clinical Pediatrics

基　　金：武汉市卫生局临床医学科研项目资助(No.武卫2007-43)

摘　　要：目的研究颈内动脉溶栓术对儿童缺血性脑血管病的临床疗效。方法收集2000年1月-2006年12月38例患儿颈内动脉溶栓术前后的临床及影像学资料,对其疗效进行总结和评价。患儿年龄9个月～11岁,应用DSA脑血管造影明确诊断后分别实施颈内动脉溶栓治疗术。溶栓治疗与偏瘫发作时间分别为:1d6例,2d2例,3～5d8例,1～2周8例,～4周4例,1～6个月4例,～12个月3例,>1年3例。治疗方法:采用经皮穿刺插管技术将导管置入患侧颈内动脉行接触法溶栓,术中尿激酶4000～5000U/次,液体量15～20ml,灌注速率1ml/min,低分子右旋糖酐10～15ml,1ml/min。结果24例(63.2%)患儿经颈内动脉溶栓治疗后结合临床综合治疗,1～2周偏瘫有效改善,患肢行走和持物功能恢复;11例(28.9%)偏瘫有所减轻,患肢肌力达到3～4级;3例(7.9%)偏瘫无改善。结论儿童缺血性脑血管病经及时行颈内动脉溶栓术结合临床综合治疗,能有效地改善脑组织供血,促进运动功能快速恢复。Objectives To investigate the efficiency of internal carotid artery thrombolytic therapy in treatment of children with isehemie cerebrovascular disease （ICD）. Methods Image and clinical data of 38 patients treated with internal carotid artery thrombolysis from Jan. 2000 to Dec. 2006 were analyzed. All patients aged from 9 months to 11 years old were treated with internal carotid artery thrombolysis after they were definitely diagnosed as ICD by DSA blood vessel of .brain angiography. The interval between hemiplegia paroxysm and the treatment starting were 1 d （6 cases）, 2 d （2 cases）, 3-5d （8 cases）, 1-2 week （8 cases）, 2-4week （4 cases）, 1-6month （4 cases）, 6- 12 month （3 cases）, and 〉 1 year （3 cases）. Seldinger% technology was adopted to put the catheter into the lesion side of internal carotid artery and complete contact thrombolytic process. 4000 - 5000 U/service urokinase, 15 - 20 ml liquid and dextran; 10 - 15 ml with 1 ml/min perfusion were given during the procedure. Results Improvement of hemiplegia and recovery of walking and holding were seen in 24 （63.2%） patients one to two weeks after the therapy, muscle power became to 3 - 4 grade in 11 cases （28.9%） and no improvement in 3 cases （7.9%）. Conclusions Timely internal carotid artery thrombolytic therapy combined with clinical complex treatment for children with ICD are efficient in improving blood supply to brain hematopoietic tissue, and accelerating motor function regain.

关 键 词：缺血性脑血管病 颈内动脉 溶栓术 儿童 

分 类 号：R743.3[医药卫生—神经病学与精神病学]