脑静脉血栓的临床特点及影像学表现分析

目的探讨脑静脉血栓(cerebral venous thrombosis,CVT)的临床资料特点、影像学特征及诊断特点。方法回顾性分析30例CVT患者的临床资料特点、影像学表现及诊断特点。结果 (1)30例患者的病因繁杂,分感染性和非感染性两类,感染性相关因素最为常见,占50%。其临床表现复杂且无特异性,主要及首要的症状为头痛。(2)30例CVT患者,经CT、MRI及MRV检查发现累及上矢状窦22例,下矢状窦1例,横窦22例,乙状窦18例,直窦5例,窦汇5例,海绵窦1例,深静脉1例,皮层静脉1例。(3)28例患者进行了CT检查,25例发现异常表现,16例出现索条征、高密度三角征;15例出现脑实质水肿、静脉性脑梗死及合并出血;30例患者均进行了MRI及MRV检查,其中29例MRI检查阳性,表现为CVT形成导致的流空效应的消失,并且出现各时期不同程度的血栓信号,漏诊的1例经MRV检查确诊;30例患者MRV检查均阳性,表现为脑静脉及静脉窦充盈缺损、信号缺失及侧支循环形成。结论CVT病因复杂,发病形式多种多样,临床表现没有特异性。CT、MRI及MRV检查是诊断CVT的无创、准确且敏感的神经影像学技术,其中MRI联合MRV诊断最重要。     

产后脑静脉及静脉窦血栓形成12例分析

目的：探讨产后脑静脉及静脉窦血栓形成CVT的病因、发病机制、临床表现诊断及治疗。方法：综合分析12例产后脑静脉及静脉窦血栓形成的患者临床资料。结果：12例患者临床均以亚急性高颅压症状为主,以上矢状窦血栓形成多见。结论：对于有妊娠和生产史,不明原因出现颅内压增高、局限性神经症状、突然意识障碍的患者,行头颅MRI或DSA检查确诊,抗凝、溶栓治疗是CVT主要治疗方法。     

老年颅内静脉血栓形成的临床及影像学分析

颅内静脉血栓形成(cerebral venous thrombosis, CVT)是一种特殊类型的脑血管病,约占脑血管病的0.5％～1％[1,2].由于妊娠、产褥期、口服避孕药等女性特异性危险因素,中青年女性CVT相对多见,老年人发病率相对较低[1,3].在人口老龄化的社会背景下,正确认识老年CVT患者的危险因素、临床...     

脑静脉窦血栓形成的影像学检查及临床特征

目的:探讨脑静脉窦血栓形成(CVT)的临床特征及影像学特点,以寻求早期识别的征象及影像策略。方法:对62例经MR或/和DSA确诊为CVT的患者临床资料及影像学特点进行回顾性分析,并予抗凝治疗。结果:62例患者中有60例有非特异性头痛,其中56例行MRI+MRV检查确诊为CVT的有54例,32例经DSA检查均确诊为DVT。结论:CVT的临床表现缺乏特异性,MRI+MRV检查是诊断DVT的首选方法,DSA是诊断CVT的"金标准"。     

脑静脉血栓形成诊治分析

颅内静脉窦及静脉均可形成血栓,病因不同致静脉血栓部位不同,但不同部位的血栓可能有一些相同的表现,因此常统称为脑静脉血栓形成(CVT)。本病发病率低,但具有潜在致命性,因其症状和体征表现多样,缺乏特异性,常误漏诊。为提高对本病的认识,回顾性分析我院1987~2006年诊治的12例CVT资料,并结合文献探讨本病诊断和治疗方法。1临床资料1·1一般资料本组12例,男3例,女9例;年龄11~54岁,平均32.6岁。病程2天~2.5年。3例在产褥期发病,2例有口服避孕药史,3例分别有高血压、糖尿病和中耳炎病史;4例未找到明确病因。1·2临床表现本组均有头痛,4例病…     

颈总动脉穿刺注射尿激酶治疗颅内静脉窦血栓形成

颅内静脉系统血栓形成(cerebral venous thrombosis,CVT)包括颅内静脉窦和静脉血栓形成,是脑血管病的一种特殊类型[1-3],其病因复杂,发病形式多样,临床表现无特异性,诊断困难,易漏诊误诊,预后差。近年我院采用颈总动脉穿刺注射尿激酶溶栓治疗颅内静脉窦血栓形成5     

上矢状窦血栓形成12例

目的:探讨脑静脉及上矢状窦血栓形成(CVT)的临床表现、影像学特征以及诊断治疗方法。方法:对近3年来我院收治的12例上矢状窦血栓形成病例的临床资料进行回顾性分析。结果:患者临床表现多样,无特异性,初诊误诊率75%。MRI联合MRV检查有助于SSST的确诊。经早期诊断、及时治疗,患者痊愈6例,好转5例,死亡1例。结论:中青年患者表现为头痛、呕吐、伴或不伴局灶性神经功能缺损,腰椎穿刺检查提示颅内压升高时应高度警惕CVT可能。围产期女性为高危人群。早期诊断、早期治疗可明显改善SSST患者的预后。     

原发性卵巢妊娠39例临床分析

目的:探讨原发性卵巢妊娠的临床特征、诊断及治疗方法.方法:对2002年-2007年收治的39例原发性卵巢妊娠临床资料进行回顾分析.结果:原发性卵巢妊娠患者平均年龄29.6±5.3岁,发生率为3.3%,29例(74.4%)有停经史,35例(89.7%)有腹痛症状,24例(61.5%)有不规则阴道出血,8例(20.5%)出现休克,23例(59.0%)放置宫内节育器,2次妊娠以上31例(79.5%),所有病例均经手术治疗.结论:原发性卵巢妊娠近年来发病呈上升趋势,发病因素与宫内节育器、多次妊娠、盆腔炎症等密切相关.应提高临床医师、B超医师对该病的认识及诊断水平,治疗以手术治疗为主.     

中心静脉留置导管在血液透析中的应用

目的 总结中心静脉置管(CVT)在血液透析中的应用,探讨导管合理留置时间和并发症的防治。方法 回顾性分析九年间我院血液净化中心对783例急、慢性肾衰患者,穿刺股静脉、锁骨下静脉和颈内静脉三个部位CVT共806例次,其中股静脉192,锁骨下静脉263,颈内静脉351例次。结果 导管留置时间:股静脉3～45(18.7±12.2)天;锁骨下静脉14～171(43.9±27.8)天;颈内静脉16～92(43.6± 22.1)天。CVT并发症发生率为12.7％,常见的有感染(4.7％),血流不畅(3.2％),出血(2.0％),局部血肿(1.5％),深静脉血栓形成(1.2％)。结论 血透应用CVT有快捷、方便、安全的优点,导管留置时间:锁骨下和颈内静脉无显著性差异,但比股静脉明显延长。并发症的发生率股静脉最高,其次为锁骨下和颈内静脉。     

介入治疗颅内静脉窦血栓的临床疗效观察

目的探讨导管法动、静脉联合治疗颅内静脉窦血栓(CVT)的疗效及安全性。方法9例由CT、MRI、DSA确诊的颅内静脉窦血栓形成患者,分别经皮股静脉及股动脉穿刺,静脉内置管于颅内静脉窦血栓处行局部溶栓治疗,动脉内溶栓则置管于颈内动脉给予尿激酶灌注溶栓。围手术期规范抗凝、抗血小板聚集等综合治疗。结果9例患者均接受了动、静脉法联合插管溶栓治疗。尿激酶使用总量(45~100)万U,平均(75.6±5.6)万U,除1例患者颅内出血加重外,其他患者均无不良反应。治疗后即刻疗效评定,3例患者临床症状明显改善,2例患者2d后临床症状明显改善,2例患者经过积极治疗出院时临床症状明显改善。2例患者临床症状改善不明显。出院时除有2例患者症状无明显改变外,另外7例患者的神经功能状态都得以改善。术后积极治疗原发病和抗凝治疗3~6个月,其中6例患者随访3~6个月不等,复查MRI无一例复发形成血栓,治疗有效率77.8%。结论动、静脉法联合治疗颅内静脉血栓的方法是可行的且安全有效。     

Ante- and postnatal risk factors of venous thrombosis: a hospital-based case–control study

Summary.  Objective:  To study ante- and postnatal risk factors of venous thrombosis (VT) in pregnancy. Methods:  A hospital-based case–control study. Cases were women with objectively verified VT during pregnancy or postpartum. Two controls were selected for each case. Validated risk factors were analyzed using chi-square test and logistic regression. Results:  In total 559 cases with no prior VT, 268 ante- and 291 postnatal cases were identified together with 1229 controls. Risk factors for antenatal VT were assisted reproduction technique (ART), antepartum immobilization, cigarette smoking, and slight weight gain (<7 kg). Conception after ART and multiple pregnancy had an additive effect, whereas antepartum immobilization and high body mass index (BMI) had a multiplicative effect on the risk for antepartum VT. No other interaction was found between risk factors for antepartum VT. Risk factors for postnatal VT were antepartum immobilization, cigarette smoking, intrauterine fetal growth restriction (IUGR), preeclampsia, emergency cesarean section, postpartum hemorrhage, infection, surgery, and age and parity. Antepartum immobilization, high BMI and reoperation on the indication of bleeding showed multiplicative effects on the risk of postnatal VT. Conclusions:  Ante- and postpartum risk factors differed markedly. More attention should be paid to pregnant women of high BMI who are immobilized.     

孕产妇孕产期静脉血栓栓塞风险评估的最佳证据总结

目的 获取国内外孕产妇孕产期相关静脉血栓风险评估的最佳证据,为构建评估工具提供参考依据.方法 应用循证医学的方法,通过计算机检索Up To Data、BMJ、Cochrane Library、JBI、GIN、NCG、NICE、CMA、RNAO、PubMed、Embase、中国知网、万方数据库、中国生物医学数据库,选取符...     

南充地区妊娠期糖尿病危险因素及妊娠结局分析

目的 探讨南充地区妊娠期糖尿病(gestational diabetes mellitus,GDM)的危险因素及妊娠结局,为南充地区育龄妇女GDM防治提供参考依据。方法 选取2018年7月1日至2019年9月30日在川北医学院附属医院产检并住院分娩的孕产妇1 800例,其中确诊GDM 537例(GDM组),血糖正常1 263例(NGT组),分析GDM的发病率、危险因素及妊娠结局。结果 南充地区GDM发病率为29.83%。年龄、居住地、产前体重指数(body mass index,BMI)、多囊卵巢综合征(PCOS)、乙型病毒性肝炎表面抗原(HBsAg)、妊娠期高血压疾病(HDP)、妊娠期甲状腺功能、瘢痕子宫、体外受精(IVF)、流产史及分娩史与GDM发病相关;GDM与剖宫产、HDP、妊娠期肝内胆汁淤积症(ICP)、产后出血、早产、巨大儿发病相关(均P<0.05)。年龄、居住地、产前BMI、PCOS、HBsAg、HDP、妊娠期甲状腺功能、IVF及流产史是GDM发病的危险因素;GDM是剖宫产、HDP、ICP、产后出血及巨大儿发病的危险因素(均P<0.05)。结论 南充地区GDM发病率可能与年龄、居住地、产前BMI、PCOS、HBsAg、HDP、妊娠期甲状腺功能、IVF及流产史有密切联系;GDM孕产妇剖宫产、HDP、ICP、产后出血及分娩巨大儿的风险较高。     

妊娠相关静脉血栓栓塞征风险评估的研究进展

随着产科医疗质量的提高,居于孕产妇死亡首位的产后出血已经得到高度的重视,而妊娠相关静脉血栓栓塞征(PA-VTE)则逐渐成为导致孕产妇死亡的首要原因之一。PA-VTE的临床特点及治疗的特殊性决定了早期评估和预防工作的重要性。本文就妊娠相关静脉血栓栓塞征的风险因素及评估现状进行综述,以期为临床孕产妇VTE风险评估及预防提供参考。     

Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study

Summary.  Background:  Venous thrombosis is one of the leading causes of maternal morbidity and mortality. Objective:  In the MEGA study, we evaluated pregnancy and the postpartum period as risk factors for venous thrombosis in 285 patients and 857 control subjects. Patients/methods:  Between March 1999 and September 2004, consecutive patients with a first episode of venous thrombosis were included from six anticoagulation clinics. Partners of patients and a random digit dialing group were included as control subjects. Participants completed a questionnaire and DNA was collected. Results:  The risk of venous thrombosis was 5-fold (OR, 4.6; 95% CI, 2.7–7.8) increased during pregnancy and 60-fold (OR, 60.1; 95% CI, 26.5–135.9) increased during the first 3 months after delivery compared with non-pregnant women. A 14-fold increased risk of deep venous thrombosis of the leg was found compared with a 6-fold increased risk of pulmonary embolism. The risk was highest in the third trimester of pregnancy (OR, 8.8; 95% CI, 4.5–17.3) and during the first 6 weeks after delivery (OR, 84.0; 95% CI, 31.7–222.6). The risk of pregnancy-associated venous thrombosis was 52-fold increased in factor V Leiden carriers (OR, 52.2; 95% CI, 12.4–219.5) and 31-fold increased in carriers of the prothrombin 20210A mutation (OR, 30.7; 95% CI, 4.6–203.6) compared with non-pregnant women without the mutation. Conclusion:  We found an increased risk of venous thrombosis during pregnancy and the postpartum period, with an especially high risk during the first 6 weeks postpartum. The risk of pregnancy-associated venous thrombosis was highly increased in carriers of factor V Leiden or the prothrombin 20210A mutation.     

孕晚期女性心理及社会支持状况对产后体质量滞留的影响

目的探讨孕晚期女性心理及社会支持状况对产后6个月体质量滞留的影响。方法采用便利抽样法,选择2015年9-10月在南昌大学第一附属医院妇产科接受产检的165名孕晚期(孕34~35周)女性为研究对象。采用自行编制的一般资料调查表、焦虑自评量表(self-rating anxiety scale,SAS)、爱丁堡产后抑郁量表(Edinburgh postnatal depression scale,EPDS)、领悟社会支持量表(perceived social support scale,PSSS)等,对孕晚期女性进行问卷调查,并于产后6个月随访,进一步调查体质量情况。结果产妇产后6个月平均体质量滞留为(5.69±2.64)kg,孕前体质质量指数、孕期增重、孕晚期焦虑、抑郁及家庭支持状况是其产后6个月体质量滞留的影响因素。结论为了预防产后体质量滞留,降低女性超重和肥胖发生率,除了产前体质量管理外,孕期女性心理状态和所获得的社会支持状况也应得到医护人员及家属的足够重视,并根据孕妇不同心理状态给予有针对性的预防和护理,以提高女性孕期和产后健康水平。     

Management of Bipolar Disorder During the Perinatal Period

Bipolar disorder (BPD) is a lifelong mental health condition characterized by symptoms of mania, depression, and often anxiety. BPD can have detrimental consequences for individuals during pregnancy and the postpartum period, as well as for their offspring. This is often due to underdiagnosis and/or misdiagnosis as unipolar depression. There is a high incidence of first episodes of BPD in pregnant and postpartum persons. Perinatal care providers need to routinely screen for BPD and assess for relapse among those with a previous diagnosis during the pregnancy and postpartum periods. Medication management is complex and must be considered in the context of an individual’s risk factors and perceptions about treatment as well as the limited evidence regarding fetal safety, using a shared decision-making model. Collaboration, consultation, and/or referral to mental health care providers are essential for managing acute and chronic BPD symptoms.     

Prophylaxis with low‐dose low‐molecular‐weight heparin during pregnancy and postpartum: is it effective?

Summary. Background: The optimal approach for venous thrombosis (VTE) prophylaxis during pregnancy and postpartum in women with an increased risk of VTE is not established. Objectives: To evaluate the effectiveness, represented as the incidence of pregnancy‐related VTE, and safety, represented as incidence of postpartum hemorrhage (PPH), of a protocol recommending prophylaxis with low‐dose low‐molecular‐weight heparin (LMWH) in women at intermediate to high risk of VTE. Patients/methods: In this retrospective cohort study, we analyzed 34 women (44 pregnancies) with intermediate risk of VTE who received low‐dose LMWH for 6 weeks postpartum and 57 women (82 pregnancies) with high risk of VTE who received low‐dose LMWH during pregnancy and for 6 weeks postpartum. Pregnancy‐related VTE was defined as VTE during pregnancy or ≤ 3 months postpartum. PPH was defined as blood loss > 500 mL and severe PPH as blood loss > 1000 mL. Results: The incidence of pregnancy‐related VTE was 5.5% (95% CI, 2.4–12.3) despite prophylaxis with low‐dose LMWH. All events occurred in women at high risk, with a postpartum incidence of 7.0% (95% CI, 2.9–16.7) and antepartum incidence of 1.8% (95% CI, 0.4–9.2). The risk of PPH was 21.6% (95% CI, 14.3–31.3) and severe PPH 9.1% (95% CI, 4.7–16.9), which was not different in women who started LMWH postpartum and those who used LMWH during pregnancy. Conclusions: Although prophylaxis with low‐dose LMWH during pregnancy and postpartum proved to be safe, the risk of pregnancy‐related VTE is considerable in women with a high risk of VTE. VTE prophylaxis with low‐dose LMWH may not be sufficiently effective in these women.     

Comparison of clinical characteristics of COVID-19 in pregnant women between the Delta and Omicron variants of concern predominant periods

BackgroundInformation regarding effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant strains on clinical manifestations and outcomes of coronavirus disease 2019 (COVID-19) in pregnant women is limited.MethodsA retrospective observational study was conducted using the data from the nationwide COVID-19 registry in Japan. We identified pregnant patients with symptomatic COVID-19 hospitalized during the study period. The Delta and Omicron variants of concern (VOC) predominant periods were defined as August 1 to December 31, 2021 and January 1 to May 31, 2022, respectively. Clinical characteristics were compared between the patients in the Delta and Omicron VOC periods. In addition, logistic regression analysis was performed to identify risk factors for developing moderate-to-severe COVID-19.ResultsDuring the study period, 310 symptomatic COVID-19 cases of pregnant women were identified; 111 and 199 patients were hospitalized during the Delta and Omicron VOC periods, respectively. Runny nose and sore throat were more common, and fatigue, dysgeusia, and olfactory dysfunction were less common manifestations observed in the Omicron VOC period. In the multivariable logistic regression analysis, onset during the later stage of pregnancy (OR: 2.08 [1.24–3.71]) and onset during the Delta VOC period (OR: 2.25 [1.08–4.90]) were independently associated with moderate-to-severe COVID-19, whereas two doses of SARS-CoV-2 vaccine were protective against developing moderate-to-severe COVID-19 (OR: 0.34 [0.13–0.84]).ConclusionsClinical manifestations of COVID-19 in pregnant women differed between the Delta and Omicron VOC periods. SARS-CoV-2 vaccination was still effective in preventing severe COVID-19 throughout the Delta and Omicron VOC periods.     

20例脑静脉(窦)血栓形成的早期诊断与治疗分析

目的：分析脑静脉窦血栓形成（CVT）的早期诊断及治疗方法。方法：回顾分析20例（男性11例，女性9例）CVT病人的发病年龄、可能病因、临床表现、影像学特征、脑脊液检查结果与治疗方法。结果：（1）年龄多在20-40岁；（2）多数病例为急性起病，病情逐渐进展；（3）病因多样；（4）早期表现为头痛（85％）、呕吐（60％），伴或不伴局灶性神经功能缺损或癫痫发作；（5）影像学表现为静脉窦闭塞及静脉性梗死灶（40％）；（6）脑脊液压力明显升高（83．3％），白细胞及蛋白含量正常或升高；（7）对因及脱水治疗基础上行抗凝治疗14例、溶栓1例，5例重症患者预后不佳。结论对临床急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的年轻病人，应高度怀疑CVT，及时行MRI及磁共振静脉血管造影（MRv）联合检查，早期明确诊断，尽可能地检查和控制潜在病因，尽早开始抗凝治疗。对重症及经肝素治疗无效的病例建议局部静脉窭内溶栓治疗。