腔内成型术治疗犬顽固性脑血管痉挛_医学论文.docVIP

腔内成型术治疗犬顽固性脑血管痉挛_医学论文 腔内成型术治疗犬顽固性脑血管痉挛_医学论文 作者：韩军良，万琪，张学昕，李力，郭以川，张魏 【关键词】 脑血管痉挛 　　【Abstract】 AIM: To investigate the efficacy of treating experimental refractory cerebral vasospasm (rCVS) with percutaneous tansluminal angioplasty (PTA) or intraartery papaverine infusion (IAP) plus PTA. METHODS: 45 adult mongrel dogs were sacrificed and 40 were used in experimental group and 5 in the control. Artery spasm was induced by twotime blood injection into brain cisterns. In the experiment group, PTA or IAP plus PTA was chosen by the status of vessels. In the control group, papaverine was given through intraveins. RESULTS: Basilar arteries of all the dogs were constricted after the twotime blood injection. In the experimental group, 20 dogs were treated by PTA but only 18 succeeded. 13 dogs in the experimental group were treated by IAP plus PTA therapy, but only 3 of them succeeded. In the control group, the spastic arteries of all dogs showed no improvement following the therapy. When reexamined 20 days later, the 21 canines treated by either PTA or IAP plus PTA all had normal angiograph, while those of the control group and those who had not successfully had PTA or IAP plus PTA in experiment group had little change. CONCLUSION: PTA is effective treatment of cerebral vasospasm. 　　【Kewords】 cerebral vasospasm angioplasty animal 　　【摘要】 目的： 探讨单纯球囊或罂粟碱联合球囊介入动脉腔内治疗顽固性脑血管痉挛的可行性和效果. 方法： 成年杂种犬45只，脑血管痉挛模型采用枕大池两次注血法. 实验组40只，根据痉挛后脑动脉径路的清晰程度的不同，采用单纯球囊或罂粟碱联合球囊血管成形术治疗；对照组5只，采用静脉内滴注罂粟碱治疗. 20 d后所有犬复查脑血管造影，再次观察疗效. 结果： 45只犬的椎基底动脉系统均发生痉挛. 实验组中痉挛椎基底动脉的径路清楚者有27只，其中接受球囊成形术治疗20只，成功18只、死亡2只，而另外的7只犬血管走行极为迂曲，无法接受球囊成形术治疗；实验组中动脉极度痉挛乃至术区血管路径没有显示者有13只，均接受了罂粟碱联合球囊治疗，仅成功3只. 对照组治疗均无效. 20 d后复查脑血管造影发现，实验组中治疗成功犬的基底动脉显影基本正常，而对照组和实验组中未能成功治疗犬的椎基底动脉仍有明显的痉挛. 结论： 血管腔内成形术是治疗顽固性脑血管痉挛的一种可靠和有效的方法. 　　【关键词】 脑血管痉挛；血管成形术；动物 　　0引言 　　顽固性脑血管痉挛(refractory cerebral vasospasm, rCVS)是大量蛛网膜下腔出血(SAH)常见的并发症，目前内外科常规的治疗措施往往无效，因而造成患者致死、致残等严重后果. 血管内介入治疗rCVS始于20世纪80年代中后期，目前在国外较大的医疗中心已成为治疗rCVS的首选措施. 本实验我们拟采用经皮腔内球囊血管成形术(PTA)和腔内罂粟碱血管