CAJ | 학술논문

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.
목적 탐토체라비반연합뇨격매개입용전치료대로내파렬동맥류행탄황권전새과정중병발혈전전새적료효화안전성. 방법 제저시제일인민의원신경외과자2010년5월지2012년2월응용전해탄황권전새로내파렬동맥류256례,기중12례발생혈전전새병발증,균급여체라비반연합뇨격매개입용전이급궤계성파전치료,매10분종조영관찰혈관용통정황,직지혈관완전혹부분재통.분석총결용전적료효. 결과 본조환자제1례위추동맥외,기여균위경내동맥계통폐새.용전후혈관완전재통9례,Gonner재통분급표준3급,1례술후지체경도편탄,여8례무명현신경공능결실；혈관대부분재통1례,Gonner분급표준2급,유경도신경공능장애,회복기인심기경사사망；완전재통1례,Gonner분급표준2급,술후좌측지체탄탄,보수치료후증상개선출원;부분혈관재통1례,Gonner분급표준2급,술후3월잔류우측지체편탄;용전치료1개월후환자격랍사가예후량표(GOS)평분1분1례,3분2례,4분2례；5분7례；술후제90천용BI지수평고환자생활상태,평분우8례,량3례,차1례. 결론 로내파렬동맥류행탄황권전새시병발적급성전새,체라비반연합뇨격매개입용전치료시안전、유효적치료수단.
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 intracranial 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 Gonner recanalization grading of grade 2,and he was given decompressive 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 thrombolytic therapy,living condition scores were excellent in 8 patients,good in 3 patients and bad in 1 patient by BI index.Conclusion Intra-arterial tirofiban and urokinase thrombolysis is an effective and safe measure for complicated thrombosis during embolization of intracranial aneurysms with coil.