儿童先天性心脏病术后并发脑梗死数字减影全脑血管造影的早期诊断与治疗

Early diagnosis and treatment with DSA in children with cerebral infarction after congenital heart disease surgery

目的探讨儿童先天性心脏病术后并发缺血性脑梗死数字减影全脑血管造影(DSA)的早期诊断及药物灌注治疗效果,并观察术后恢复情况。方法 2015-01-01—2016-12-30华中科技大学同济医学院附属武汉儿童医院收治6例先天性心脏病手术后12 h至3 d内出现神经系统症状患儿,表现为面瘫、肢体活动障碍或抽搐,并经头颅磁共振成像(MRI)检查初步诊断为缺血性脑血管病,于急诊行DSA明确诊断脑梗死。术中予以颈内动脉药物灌注治疗,术后给予改善循环、抗凝、静脉溶栓及康复治疗,分别于DSA治疗后6 h、1 d、3 d、1周、1个月观察患儿临床症状恢复情况,随访1~3个月。结果 6例患儿均成功行DSA及药物灌注治疗,临床症状明显改善。其中5例分别于DSA治疗后6 h、第1天、第2天面瘫症状较前好转,且肢体肌力开始逐渐恢复;2例第3天肢体活动障碍逐渐好转。患儿随访肌力明显恢复,未发生复发及其他较严重并发症和严重后遗症(无DSA围手术期出血、感染,随访后期患儿无认知功能障碍及肢体残疾)。结论先天性心脏病手术后合并脑梗死患儿早期诊断至关重要,可尽早开展选择性脑血管造影,DSA及药物灌注治疗能有效改善脑组织供血,促进运动功能恢复,改善患者临床症状。

Objective To approach the performance of digital subtraction angiography（DSA）in the early diagnosis and treatment with drug perfusion therapy in children with cerebral infarction after the congenital heart disease surgery,then assess the outcome. Methods From January 2015 to December 2016,6 patients with cerebral infarction developed neurologic symptoms,including facial paralysis,physical activity disorders or convulsions within 12 hours to 3 days after surgery for congenital heart disease. After being diagnosed with ischemic cerebrovascular disease by initial magnetic resonance imaging（MRI）,patients were made a definite diagnosis through DSA and given intravenous infusion of internal carotid artery at the same time. Patients were treated to improve circulation,anticoagulation,intravenous thrombolysis and rehabilitation after DSA.Clinical symptoms were observed at 6 hours,1 day,3 days,1 week and 1 month after operation. Patients were followed up for 1 month to 3 months. Results After successful DSA surgery and drug perfusion therapy,neurologic symptoms in patients were improved. Facial paralysis was improved in 5 of 6 patients at 6 h,1 d and 2 d of DSA,and limb muscle strength was also improved. Physical activity was gradually improved in 2 patients at the third day after DSA surgery. All cases had no signs of recurrence,serious complications or sequalae（no DSA perioperative bleeding,infection,cognitive dysfunction or physical disability）in the follow-up,and muscle strength was significanthy improved. Conclusion The early diagnosis is crucial to children with cerebral infarction after the surgery for congenital heart disease.