颈动脉注射尿激酶联合抗凝治疗脑静脉窦血栓11例疗效观察

Clinical observation of urokinase injection via common carotid artery combined with anticoagulation in 11 patients with cerebral venous sinus thrombosis

目的探讨颈动脉注射尿激酶联合抗凝治疗脑静脉窦血栓的有效性、可行性。方法对11例脑静脉窦血栓患者两侧颈动脉交替注射尿激酶10万单位,1次/d,共5~7d。同时根据监测凝血酶原时间和活动度结果口服华法林钠抗凝治疗,每日2.5~7.5mg,1次/d,服1~2年。结果联合治疗7d后,8例临床症状消失,脑脊液压力恢复到正常范围,脑动静脉循环时间降至11s内（DSA证实）,静脉窦再通,临床治愈;3例患者临床症状好转。无脑出血及全身出血等不良反应。11例患者脑脊液平均下降（1.79±1.23）kPa,脑动静脉循环时间平均缩短（9.04±6.44）s,两项治疗前后差异均有统计学意义（P〈0.01）。结论颈动脉内注射尿激酶溶栓并联合全身抗凝是治疗脑静脉窦血栓的一种有效、安全的方法,此方法也可以治疗该病并发的脑出血。

Objective To investigate clinical effect and feasibility ofurokinase injection via common carotid ar- tery in combination with anticoagulation therapy in the treatment of cerebral venous sinus thrombosis. Methods Eleven patients with cerebral venous sinus thrombosis were injected with 100 000 IU urokinase via bilateral common carotid arteries alternately, once a day for 5~7 days. At the same time, according to the results of prothrombin time and pro- thrombin activity, all the patients were given general anticoagulation with oral administration of warfarin, 2.5~7.5 mg once a day for 1-2 years. Results After 7 day＇s of treatment, clinical symptom disappeared in 8 cases, with ce- rebrospinal fluid pressure decreased to normal range and cerebral arteriovenous circular time down to 11 s （eon- firrned by DSA）. The eight patients were cured clinically with recanalization of cerebral venous sinus. The clinical symptoms were improved obviously in 3 cases. No local hematoma or systemic hemorrhage occurred. Cerebrospinal fluid pressure of the 11 patients decreased by （1.79＋ 1.23） kPa on average, with cerebral aeteriovenous circulation time by （9.04＋6.44） s, with statistically significant difference before and after treatment （P〈0.01）. Conclusion In- jection of urokinase via common carotid artery combined with general anticoagulation is effective and safe for treating cerebral venous sinus thrombosis, which can also be used to treat cerebral hemorrhage caused by cerebral venous sinus thrombosis.