血管内治疗与单纯抗凝治疗颅内静脉窦血栓形成的疗效分析

目的对比评价血管内治疗与单纯抗凝治疗对颅内静脉窦血栓形成的疗效。方法收集40例经临床和MRI、MR静脉造影诊断为颅内静脉窦血栓患者,分为A组（单纯抗凝治疗组,20例）,方法为静脉内输入肝素100mg/24h,持续3d后长期口服华法林,维持至半年;B组（血管内治疗组,20例）,行静脉内局部溶栓联合机械性碎栓,其中12例采用了球囊扩张,2例行支架置入,1例联合动脉溶栓。术后积极治疗原发病,抗凝治疗6个月。分别在治疗前、后（3d及3、6、12个月）的不同时点对患者的主要症状——头痛,通过目测类比法（VAS）评分;用美国国立卫生研究院卒中量表（NIHSS）对患者在治疗前后的不同时期行神经功能评分。结果①在治疗后3d,A组患者VAS评分为8.2±2.3,B组患者为3.5±1.6;治疗后3个月时,A组患者VAS评分为4.9±1.4,B组为2.2±1.5,两组相比,差异均有统计学意义（P〈0.01,P〈0.05）。②在治疗后3d及3、6、12个月时,A组患者的NIHSS评分分别为14.7±2.0、10.4±1.4、9.5±1.9和7.1±1.2;B组患者评分分别为9.0±0.8、7.0±1.7、6.1±2.2和5.5±2.1。同时间点两组评分相比,差异均有统计学意义（均P〈0.05）。结论血管内治疗颅内静脉窦血栓较单纯抗凝治疗,能够较快地缓解患者的主要症状并改善患者的预后。

Comparison of the therapeutic effect between interventional treatment and anticoagulation therapy alone in patients with intracranial venous sinus thrombosis

Objective To compare evaluate the efficacy of interventional thrombolysis and the anti- coagulation therapy alone for intracranial venous sinus thrombosis. Methods Forty patients were diagnosed as intracranial venous sinus thrombosis by clinical, MRI, and MRV examination. They were divided into anticoagulation therapy group （ group A, n = 20 ） and interventional treatment group （ group B, n = 20）. Heparin 100 rag/24 h was infused intravenously during the first 3 days, and after that warfarin was administered orally for half a year in patients of group A; Interventional thrombolysis in combination with mechanical thrombus maceration, balloon or stent angioplasty were performed and anticoagulant therapy was continued for 6 months in patients of group B. The present symptom （headache） of the patients was scored by visual analog scale （VAS） at the different time points before and 3 days, 3, 6 and 12 months after the treatment. The neurological function of the patients at the different time points before and after the treatment were evaluated by the National Institutes of Health Stroke Scale （N1HSS）. Results （1）The VAS score was 8.2 ± 2.3 three days ＇after the treatment in group A, and it was 3.5 ± 1.6 in group B ; the VAS score was 4.9 ± 1.4 three months after the treatment in group A, and it was 2.2 ± 1.5 in group B. There were significant differences between the two groups （ P 〈 0.05 ）. （2）The NIHSS scores were 14.7 ± 2.0, 10.4 ±1.4, 9.5 ± 1.9, and 7. 1 ± 1.2 respectively at 3 day, 3, 6, and 12 months after the treatment in group A, and they were 9.0 ±0. 8, 7.0 ± 1.7, 6.1 ± 2.2, and 5.5 ± 2.1 in group B. There were significant differences between the two groups at the same time point （P 〈0.01, P 〈 0.05）. Conclusion Interventional treatment for intraeranial venous sinus thrombosis may relieve the present symptoms of the pa-tients and improve their prognosis faster than anticoagulant therapy alone.