超声引导下手法压迫联合小剂量凝血酶注射治疗医源性股动脉假性动脉瘤  

Manual compression with small dosage thrombin injection for treating the patients of iatrogenic femoral pseudoaneurysm under ultrasound guidance

作　　者：刘桂林 王雪飞[1] 姬旭 陈鹏[1] 王少松[1] Liu Guilin;Wang Xuefei;Ji Xu;Chen Peng;Wang Shaosong(Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing Key Laboratory of Acupuncture Neuromodulation,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院针灸中心,针灸神经调控北京市重点实验室,100010

出　　处：《中华脑血管病杂志（电子版）》2023年第6期571-575,共5页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：中医药循证能力建设项目(2019XZZX-ZJ002);北京市属医院科研培育计划项目(PZ2019019);北京市医院管理中心重点医学专业项目(ZYLX202140)。

摘　　要：目的探讨超声引导下手法压迫联合小剂量凝血酶注射治疗脑血管介入股动脉穿刺后假性动脉瘤(PSA)的效果。方法回顾性分析2017年7月至2022年6月首都医科大学附属北京中医医院13例脑血管介入诊疗后股动脉PSA患者的临床资料,其中男性10例,女性3例。首先应用超声定位股动脉PSA瘤体、瘤颈及供应动脉位置,标记PSA瘤腔距离表皮最近处,然后在超声引导下将20号穿刺针进入瘤腔中心,将浓度为200 U/ml的凝血酶溶液1~2 ml,匀速缓慢注入瘤腔内,填充80%~90%时停止,后手法压迫5~10 min,之后应用绷带加压包扎,平卧24 h,术后24 h和2个月复查超声。结果12例(92.3%,12/13)患者一次治疗成功,1例(7.7%,1/13)患者二次注射成功,发生过敏反应者1例(7.7%,1/13)。13例患者术后均需要口服抗血小板药物(阿司匹林或硫酸氢氯吡格雷),随访2个月,动脉瘤均未复发,治愈率为100%,效果满意。结论超声引导下采用手法压迫联合小剂量凝血酶注射治疗股动脉穿刺后PSA,操作安全有效。Objective To study the efficiency of manual compression with small dosage thrombin injection for treating the patients with iatrogenic femoral pseudoaneurysm after cerebrovascular interventional therapy under ultrasound guidance.Methods A total of 13 patients suffering from post-cerebrovascular interventional therapy iatrogenic femoral pseudoaneurysm at Beijing Hospital of Traditional Chinese Medicine from July 2017 to June 2022 were analyzed including 10 male and 3 female.At first,the body,the neck,and the blood supply area of pseudoaneurysm were located by ultrasonography.The skin puncturing point of nearest to pseudoaneurysm body was marker.20 gauge needle with thrombin was punctured into the center of the pseudoaneurysm,with the dosage of 1-2 ml,solution concentration 200 U/ml.The speed was slow and the injection stopped when the tumor cavity was filled about 80%-90%.Manual Compression was conducted for 5-10 mins followed by bandage compression.The patients were in a horizontal position for 24 hours.Ultrasonography was performed at 24 hours and 2 months after the operation in all patients,respectively.Results 12 patients(92.3%)were treated successfully at one time.The other one patient(7.7%)was injected twice to succeed and the other one patient(7.7%)had an allergic reaction.All the patients needed to take oral antiplatelet drugs(Aspirin or Clopidogrel),and followed-up for 2 months.The pseudoaneurysm did not recur.And the overall success rate was 100%,with satisfactory the efficiency.Conclusion Manual compression with small dosage thrombin injection for treating the patients of iatrogenic femoral pseudoaneurysm under ultrasound guidance is a safe and effective method,which has high clinical application value.

关 键 词：假性动脉瘤 超声引导 凝血酶 手法压迫 

分 类 号：R743.4[医药卫生—神经病学与精神病学]