数字减影血管造影应用于小儿缺血性脑血管病的诊断与介入治疗

The value of digital subtraction angiography in diagnosis and planning endovaseular treatment of children with ischemic eerebrovascular diseases

目的探讨数字减影血管造影（DSA）在小儿缺血性脑血管病中的诊断和介入治疗的价值。方法31例疑有缺血性脑血管病的患儿经DSA确定部位后，再通过导管注入尿激酶、右旋糖酐以观察注药后血管影像学变化，同时观察临床症状及体征有否改善。结果31例中24例（77％）示脑血管异常改变，其中脑动静脉畸形2例，后交通动脉瘤1例，大脑动脉狭窄或闭塞病变21例。21例脑动脉狭窄或闭塞病变者行介入灌注治疗后，即刻观察肌力变化有不同程度提高。其中肌力提高1级的13例，提高2级的3例，提高3级的2例，无明显改善的3例。即刻肌力提高率达86％。7例狭窄血管100％开通；血管闭塞12例，完全再通3例，部分再通7例，不通2例。结论DSA能够提高缺血性脑血管病的检出率，是评价脑血管狭窄、闭塞和选择治疗方案的金标准，它对缺血性脑血管病的进一步治疗起着决定性的作用。

Objective To evaluate the value of digital subtraction angiography（DSA） in diagnosis and planning endovascular treatment of cerebrovascular diseases. Methods Thirty-one children suspected with ischemic cerebrovascular diseases were treated by urokinase and dextran after they underwent DSA. Results Twenty-four cases （77%） had cerebrovascular abnormalities. Two cases had arteriovenous malformations, 1 case had posterior communicating artery aneurysm,21 cases had cerebrovascular stenosis or occlu- sions. Shortly after intervention therapy using urokinase,muscle strength increased by one level in 13 cases, two levels in 3 cases,3 levels in 2 cases and no effect in 4 cases. The total effective rate reached 86%. Seven patients with ischemic stroke achieved 100% recanalization. Conelusion DSA is very important in diagnosis of cerebrovascular stenosis and occlusion.