替罗非班联合尿激酶治疗破裂动脉瘤弹簧圈栓塞过程中急性血栓形成  

Interventional tirofiban urokinase thrombolysis for complicated thrombosis during embolization of intracranial aneurysms with GDC coil

作　　者：冯雷[1] 冯光 陈剑[1] 刘军[1] 苏春海[1] 刘运振[1] 

机构地区：[1]济宁市第一人民医院血管神经外科,272111 [2]长沙市第八人民医院神经外科,410100

出　　处：《中华神经医学杂志》2013年第5期490-493,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨替罗非斑联合尿激酶介入溶栓治疗对颅内破裂动脉瘤行弹簧圈栓塞过程中并发血栓栓塞的疗效和安全性。方法济宁市第一人民医院神经外科自2010年5月至2012年2月应用电解弹簧圈栓塞颅内破裂动脉瘤256例，其中12例发生血栓栓塞并发症，均给予替罗非班联合尿激酶介入溶栓以及机械性破栓治疗，每10分钟造影观察血管溶通情况．直至血管完全或部分再通。分析总结溶栓的疗效。结果本组患者除1例为椎动脉外，其余均为颈内动脉系统闭塞。溶栓后血管完全再通9例，Gonner再通分级标准3级，1例术后肢体轻度偏瘫，余8例无明显神经功能缺失；血管大部分再通1例，Gonner分级标准2级，有轻度神经功能障碍，恢复期因心肌梗死死亡；完全再通1例，Gonner分级标准2级，术后左侧肢体瘫痪，保守治疗后症状改善出院；部分血管再通1例，Gonner分级标准2级，术后3月残留右侧肢体偏瘫；溶栓治疗1个月后患者格拉斯哥预后量表（GOS）评分1分1例，3分2例，4分2例；5分7例；术后第90天用BI指数评估患者生活状态，评分优8例，良3例，差1例。结论颅内破裂动脉瘤行弹簧圈栓塞时并发的急性栓塞，替罗非斑联合尿激酶介入溶栓治疗是安全、有效的治疗手段。Objective To evaluate the efficacy of interventional trofiban and urokinase thrombolysis on complicated thromboembolism and its risk during embolization of ruptured intracranial aneurysms with GDC coil. Methods Twelve of 256 patients with ruptured intmcranial aneurysms performed coil embolization in our hospital from May 2010 to February 2011 were chosen in our study; acute thromboembolic complications happened during the embolization, and continued aneurysms embolization was performed. Within 1 hour after thrombosis, all the 12 patients were given interventional tirofiban and urokinase thrombolysis combined with mechanical thrombus maceration under cerebral angiography surveillance. Angiogram was performed to assess the vascular thrombolysis situation every 10 minutes until the vessels achieved complete or partial recanalization. Thrombolytic efficacy was concluded. Results All patients were the occlusion in the internal carotid artery system, except one of vertebral artery system type. Nine patients achieved complete vascular recanalization after thrombolysis with Gonner recanalization grading of grade 3, and one of them had limb hemiparesisas and the other 8 did not show neurological deficits; one patient achieved subtotal recanalization with Gonner recanalization grading of grade 2, and mild neurological dysfunction was noted, and then, he died of myocardial infarction in recovery; one patient achieved complete vascular recanalization after thrombolysis with Gonner recanalization grading of grade 2, and he had paralysis of the left limbs, received conservative treatment and discharged with mild paralysis 3 months after treatment; the last one obtained partial recanalization with Gouner recanalization grading of grade 2, and he was givendecompressive craniectomy and discharged with residual right limb hemiparesis 3 months after treatment. One month after thrombolytic therapy, one patient had 1 score, 2 had 3 scores, 2 had 4 scores and 7 had 5 scores in Glasgow Outcome Scale （GOS）. Three months after thromb

关 键 词：替罗非斑 尿激酶 弹簧圈 介入溶栓 颅内动脉瘤 

分 类 号：R743.33[医药卫生—神经病学与精神病学]