联合治疗方案与全身抗凝治疗脑静脉窦血栓形成

目的 比较脑静脉窦血栓形成的联合治疗方案与全身抗凝在临床应用中的有效性和安全性.方法 网顾性连续收集脑静脉窦血栓形成116例患者资料,根据治疗方式不同分为联合治疗组30例和全身抗凝组86例.其中联合治疗组在全身抗凝的基础上,接受改良溶栓方案介入治疗,即脑动脉及静脉窦造影明确诊断后行机械性破栓及吸栓术,于静脉窦内留置微导管行尿激酶微量泵点接触性溶栓.采用NIHSS评分对两组患者治疗前后神经功能缺损评分,应用改良Rankin量表(mRS)评价出院时情况.结果 联合治疗组30例,男9例；全身抗凝组86例,男23例.治疗前神经功能缺损:联合治疗组0～19分,全身抗凝组0～17分,差异无统计学意义(Z=-0.474,P=0.636)；治疗后联合治疗组神经功能缺损程度减轻,出院时mRS评分较低,两组颅内出血发生率差异无统计学意义.结论 联合治疗较全身抗凝有利于神经功能恢复.两种治疗方法颅内出血发生率无明显差异.

Clinical analysis with combined thrombolysis versus systemic anticoagulation for cerebral venous and sinus thrombosis

Objective To compare the safety and efficacy of combined thrombolysis and systemic anticoagulation therapy for the treatment of cerebral venous and sinus thrombosis (CVST).Methods A retrospective review of consecutive inpatients with CVST was undertaken. Patients were divided into two groups,combined thrombolysis group (CTG) and systemic anticoagulation group (SAG).CTG underwent improved thrombolysis scheme which included mechanical thrombus maceration and unremitting microdosis urokinase injection into the venous sinus besides low molecular weight heparin anticoagulation.Neurological deficits before and after treatment were graded with the National Institute of Health Stroke Scale (NIHSS).Functional outcomes at discharge were graded on the modified Rankin Scale (mRS).Results There were 30 cases in CTG ( male =9) and 86 cases in SAG ( male =23 ).There was no significant difference of neurological deficits before treatment between two groups(0-19 vs 0-17,Z =-0.474,P =0.636).After treatment,NIHSS and mRS at discharge were significantly decreased in CTG compared to SAG.There was no significant difference on the incidence of intracerebral hemorrhage.Conclusions Combined thrombolysis is better than systemic anticoagulation in improving neurological function.Combined thrombolysis does not increase incidence of ICH compared to systemic anticoagulation.