上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗颅内静脉窦血栓形成（9例报道）  

Thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus for patients with intracranial venous sinus thrombosis： a report of nine cases

作　　者：徐光军[1] 姜桂生[1] 徐军[1] 卑产谢[1] 杜景卫[1] 孙义华[1] 杨霞峰[1] 李延辉[1] 

机构地区：[1]聊城市人民医院神经内科,252000

出　　处：《中华神经医学杂志》2012年第8期819-822,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗颅内静脉窦血栓形成的疗效和安全性。方法聊城市人民医院神经内科自2008年1月至2011年1月对9例难治性颅内静脉窦血栓形成患者进行了上矢状窦远端置管持续尿激酶泵人接触性溶栓治疗．辅以机械性血栓切割，以血栓全部或大部分溶解、闭塞的脑静脉窦主干再通为停止溶栓指征。术后积极治疗原发病及抗血小板聚集治疗6个月。出院后随访9～30个月，内容包括腰穿、眼底检查和MRV或DSA检查。结果出院时9例患者的闭塞静脉窦均再通，动静脉循环时间正常，皮层静脉和深静脉恢复正常，临床症状改善，颅内压恢复，眼底水肿明显减轻或消失，GCS评分由术前平均10分恢复到15分，未出现与血管内治疗相关的并发症；平均随访20个月后无一例患者血栓再形成．未出现新的神经功能缺失症状。结论上矢状窦远端置管持续尿激酶泵人接触性溶栓治疗颅内静脉窦血栓形成是一种安全、有效的治疗手段。Objective To evaluate the efficacy and safety of thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus for patients with intracranial venous sinus thrombosis. Methods Nine patients with intracranial venous sinus thrombosis, admitted to our hospital from January 2008 to January 2011, were treated with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus, assisting with mechanical thrombus maceration. The indication of stopping thrombolysis was that thrombolysis had been completely or mostly finished and the bole of obstructive cerebral sinus venous had been re-canalized. After the operation, treatments aimed at the primary diseases were continued and anti-platelet aggregation treatment was given for 6 months. The followed-up data were obtained at 9-30 months （averaged 20 months）. The followed-up examinations were carried out once every 6 months, including lumbar puncture, fundus examination, and MRV or DSA. Results At discharge, all of the 9 patients achieved recanalization of cerebral venous sinuses. Arteriovenous circulation time was returned to normal; pallium vein and deep vein were put back. Clinical symptoms of all the patients were improved. Intracranial pressure recovered. Eyeground edema obviously lightened or disappeared. Glasgow coma scale （GCS） scores regained 15 points at discharge from an average of 10 points before thrombosis. No endovascular treatment-related complications were noted. During follow-up, no patients recurred. Conclusion Thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus is an effective and safe procedure for patients with intracranial venous sinus thrombosis.

关 键 词：血栓形成 颅内静脉窦 上矢状窦 溶栓治疗 尿激酶 

分 类 号：R743.32[医药卫生—神经病学与精神病学]