颅内静脉血栓的介入治疗_医学论文.docVIP

颅内静脉血栓的介入治疗_医学论文 颅内静脉血栓的介入治疗_医学论文 作者：吕 梁， 乔 杰，　罗 宁， 华 健 【摘要】 目的 探讨导管法动、静脉联合治疗颅内静脉血栓(CVT)的疗效及安全性。方法 9例由CT、MRI、DSA确诊的颅内静脉血栓形成患者，分别经皮股静脉及股动脉穿刺，静脉内置管于颅内静脉窦血栓处行局部溶栓治疗，动脉内溶栓则置管于颈内动脉给予尿激酶灌注溶栓。围手术期规范抗凝、抗血小板聚集等综合治疗。 结果 9例患者均接受了动、静脉法联合插管溶栓治疗。尿激酶使用总量45～100万u，平均75.6±5.6万u，除1例患者颅内出血加重外，其余患者均无不良反应。治疗后即刻疗效评定，3例患者临床症状即刻改善。2例患者2天后临床症状明显改善。2例患者经过积极治疗直至出院时临床症状明显改善。2例患者临床症状改善不明显。出院时除有2例患者无明显改变外，另外7例患者的神经功能状态都获得改善。术后积极治疗原发病和抗凝治疗3～6个月，其中6例患者获得随访3～6个月不等，复查MRI无1例复发形成血栓，治疗有效率77.8%。 结论 动、静脉法联合治疗颅内静脉血栓的方法是可行的且安全有效。 【关键词】 颅内静脉窦； 血栓形成； 动脉法溶栓；静脉法溶栓： 溶栓治疗；介入治疗 【Abstract】 Objective To evaluate the efficacy and safety of endovascular thrombolytic therapy. Methods The authors reviewed the experience of endovascular treatment for 9 patients with cranial venous thrombosis. All patients confirmed by CT，MRI and/or DSA were treatment with endovascular infusion of urokinase including intravenous thrombolytic and intraateral thrombolytic.After thrombolytic treatment， aimed at the primary disease was continued and warafrin was used. Results All of the 9 patients underwent endovascular infusion of urokinase .The infusion dose of urokinase was 450000～1000000U， the average dose of urokinase was 756000±56000 U. 9 Patients except one cranial bleeding aggravated， all the others have no complications before hospital discharged. All the patients had improved neurologically except two patients. After hospital discharged， treatment aimed at the primary disease was continued and warfarin was used for 3months to 6months， no patients recurred confirmed by taken MRI studies ，the improvement rate was 77.8%. Conclusion Endovascular thrombosis therapy is an effective and safe measure for cranial venous thrombosis. 【Key words】 cerebral venous sinuses ； thrombosis； intraarteral thrombolytic； intravenous thrombolytic； interventional therapy； thrombolytic therapy 颅内静脉血栓形成 (cerebral venous thromboses， CVT)作为脑血管病的一种特殊类型， 其预后有很大程度的不可预测性 ，尚无统一治疗模式，现应用的治疗方法取决于基本的病因和病理改变。由于早期对CVT的研究均建立在尸检的基础上，故多认为CVT患者很难免于死亡。脑血管造影技术应用到临床后，