颅内静脉窦血栓形成的临床分析
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Clinical analysis of cerebral venous sinus thrombosis
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    目的:探讨抗凝和静脉窦溶栓治疗颅内静脉窦血栓形成(CVST)的有效性和安全性。方法:回顾性分析24例CVST患者的临床资料,出院后随访1~3年。结果:本组患者中,16例只接受低分子肝素抗凝治疗,8例为抗凝结合静脉窦局部溶栓治疗。入院时临床表现为单纯颅高压者8例,合并局灶症状体征者11例,合并脑病2例,昏迷3例。2种治疗方法均取得较好疗效。随访期末,17例(71%)患者完全恢复,3例(13%)遗留后遗症状,4例(17%)患者死亡。本研究显示,合并颅内出血并不是CVST预后不良的独立危险因素。精神障碍-昏迷及多部位的静脉窦血栓仍是预后差的主要危险因素,而单发部位的CVST及溶栓合并抗凝治疗是短期预后良好的独立预测因素。结论:2种方法均有较好的疗效和安全性。与单纯抗凝治疗相比,静脉窦内溶栓治疗是积极-安全有效的治疗方法,可改善出现颅内出血和昏迷患者的临床预后。

    Abstract:

    Objective:To explore the efficacy and safety of anticoagulant therapy and local thrombolytics in patients with cerebral venous and sinus thrombosis(CVST). Methods:The clinical data of 24 patients with CVST were retrospectively analyzed. These patients were observed after discharge and followed up for 1~3 years. Results:In all the patients included,16 patients only anticoagulated with heparin,8 patients received anticoagulation with heparin and local thrombolytic treatment. At admittion,8 cases showed isolated intracranial hypertension,11 cases with focal deficit,2 cases with encephalopathy and 3 cases with coma. Both the anticoagulation and local thrombolytics were effective. At the end of the follow-up,17 cases (71%) were independent,3 cases (13%) were dependent and 4 cases(17%) died. Concomitant haemorrhageic infarcts related to CVST before treatment were not associated with a poor outcome. Independent predictors of poor outcome were mental disturbance,coma,multiple CVST while predictors of good outcome were thrombosis of single sinus and thrombolytic treatment followed by anticoagulant treatment. Conclusion:In our study,both the heparin therapy and local thrombolysis showed the safety and efficacy in patients with CVST. Local thrombolysis may be a therapeutic option for patients at high risk for a poor outcome despite heparin therapy,possibly in those with intracranial haemorrhages and coma.

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程 虹,刘 圣,万 琪,葛 颂,张 廉,顾 萍,张 磊,龚 洁,王兴霞.颅内静脉窦血栓形成的临床分析[J].南京医科大学学报(自然科学版),2013,(8):1126-1130

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  • 收稿日期:2012-11-19
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  • 在线发布日期: 2013-07-30
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