脑梗死动脉溶栓并发出血中静脉充盈早现探析

Early venous filling in hemorrhagic complications after acute cerebral infarction intra-arterial thrombolysis

目的探讨动脉溶栓中静脉充盈早现与溶栓并发脑出血的关系。方法纳入急性脑梗死患者320例,其中男性162例,女性158例,使其接受动脉溶栓治疗,并同时进行脑血管造影,判断有无静脉充盈早现,如若出现静脉充盈早现,即停止动脉溶栓,统计静脉充盈早现及脑出血的发生率。结果105例患者有静脉充盈早现(32.8%),其中男性65人(61.9%),女性40人(31.8%)。其中大脑大静脉充盈21例(6.6%),并发脑出血10例(3.1%);大脑内静脉充盈20例(6.3%),并发脑出血8例(2.5%);岩部静脉充盈19例(5.9%),并发脑出血11例(3.4%);丘纹上静脉充盈25例(7.8%),并发脑出血12例(3.8%)。其中男性53人(16.6%),女性32人(10%)。大脑皮质浅静脉充盈为20例(6.2%),并发脑出血4例(1.3%)。其中男性12人(3.8%),女性8人(2.5%)。无静脉充盈早现的215例患者中并发脑出血2例(0.6%)。有静脉充盈早现者各亚型脑出血的发生率均较无静脉充盈早现者脑出血的发生率高且差异具有统计学意义(P<0.05),大脑深静脉充盈者各亚型脑出血的发生率均较脑皮质静脉充盈者脑出血发生率高且差异具有统计学意义(P<0.05)。男性静脉充盈早现并发脑出血的发生率较女性高且差异具有统计学意义(P<0.05)。结论动脉溶栓中静脉充盈早现(尤其大脑深静脉充盈早现各亚型)高度提示动脉溶栓脑出血风险。男性静脉充盈早现并发脑出血的风险较女性更高。

Objective To determine the relationship between appearance of angiographic early venous filling during intra-arterial reperfusion therapy and hemorrhagic complications. Methods Three hundred and twenty patients with acute cerebral infarction underwent superselective local angiography during intra-arterial reperfusion therapy to evaluate the presence of early venous filling. Reperfusion therapy was discontinued just after appearance of early venous filling.There were two types of early venous filling： early filling of the thalamostriate vein and early filling of the cortical vein. The rate of early venous filling and hemorrhagic complications was recorded. Results Early venous filling occurred in 105 cases(32. 8%） of which 65 were male（61. 9%） and 40 were female（38. 1%）. The filling of the cerebral venous plexus in 21 cases（6. 6%）,and complicated with cerebral hemorrhage in 10 cases（3. 1%）; intracerebral vein filling in 20 cases（6. 3%）,with cerebral hemorrhage in 8 cases（2. 5%）,cavernous venous infusion in 19 cases（5. 9%）,and with cerebral hemorrhage in 11 cases（3. 4%）,and25 cases（7. 8%） of the upper vein in the vena cava,with 12 cases（3. 8%） of cerebral hemorrhage. All the deep brain venous filling including 53 men（16. 6%） and 32 women（10%）.The cerebral cortex superficial vein filling was in 20 cases（6. 2%）,complicated with cerebral hemorrhage in 4 cases（1. 3%）,including 12 males（3. 8%） and 8 females（2. 5%）. There were 2 cases of cerebral hemorrhage complicated by 215 cases of early venous infusion（0. 6%）. The incidence of intracerebral hemorrhage in patients with early venous insufflation was higher and the difference was statistically significant(P〈0. 05）. Among them,deep cerebral veins(large cerebral veins,intracerebral veins,petrous veins,and supraorbital veins）were filled with venous hemorrhage. The incidence was higher and the difference was statistically significant(P〈0. 05）. The incidence of early onset cerebral hemorrhage in males with venous filling was higher and the difference was statistically significant(P〈0. 05）. Conclusion Premature venous filling in arterial thrombolysis predicts the risk of intracerebral hemorrhage in arterial thrombolysis. Cerebral hemorrhage is more likely to be a risk for cerebral venous insufflation. The risk of early occlusal cerebral hemorrhage in male venous insufflation is higher.