CAJ | 학술논문

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入接触性溶栓治疗,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入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.
목적 탐토상시상두원단치관지속뇨격매빙입접촉성용전치료로내정맥두혈전형성적료효화안전성. 방법 료성시인민의원신경내과자2008년1월지2011년1월대9례난치성로내정맥두혈전형성환자진행료상시상두원단치관지속뇨격매빙입접촉성용전치료,보이궤계성혈전절할,이혈전전부혹대부분용해、폐새적뇌정맥두주간재통위정지용전지정.술후적겁치료원발병급항혈소판취집치료6개월.출원후수방9～30개월,내용포괄요천、안저검사화MRV혹DSA검사. 결과 출원시9례환자적폐새정맥두균재통,동정맥순배시간정상,피층정맥화심정맥회복정상,림상증상개선,로내압회복,안저수종명현감경혹소실,GCS평분유술전평균10분회복도15분,미출현여혈관내치료상관적병발증；평균수방20개월후무일례환자혈전재형성,미출현신적신경공능결실증상. 결론 상시상두원단치관지속뇨격매빙입접촉성용전치료로내정맥두혈전형성시일충안전、유효적치료수단.
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 intracraniai 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.