颅内静脉窦血栓急性期治疗策略的初步研究

目的探讨颅内静脉窦血栓(CVST)急性期的临床特点及治疗策略的选择。方法回顾性分析26例急性期CVST患者的临床资料,住院期间分别接受全身抗凝、静脉溶栓和血管内治疗,并辅助华法林口服6~12个月。结果26例急性期CVST患者中16例患者接受单纯全身抗凝药物治疗,6例接受单纯静脉溶栓,4例接受全身抗凝+血管内溶栓治疗(其中2例因抗凝治疗过程中,病情加重,转为血管内溶栓治疗)。出院时,所有患者闭塞静脉窦均再通或部分再通,临床症状改善。随访6~26月,平均18月,无一例血栓再形成。结论急性期CVST应根据病情程度选择个性化治疗方案,其影响因素为临床表现、闭塞程度及侧支循环开放程度。

Preliminary study on the treatment strategies of acute cerebral vein sinus thrombosis

Objective The aim of this study is to discuss the clinical characteristic and the selection of treatment of acute cerebral vein sinus thrombosis. Methods Clinical data of 26 patients diagnosed with acute CVST were retrospectively analyzed. These patients were treated with simple anticoagulant therapy,intravenous thrombolytic therapy,and endovascular thrombolysis. Then all the patients took oral warfarin for 6 ～ 12 months. Results Among 16 patients who received systemic anticoagulant therapy,13 were cured,3 were improved. Among 6 patients who accepted intravenous thrombolytic therapy,4 were cured,2 were improved. Among 4 patients who accepted endovascular thrombolysis,3 were cured,1was improved. The period of follow-up was between 6 months and 26 months（ the median time was 18 months）,and no recurrence happened or reported. Conclusion Personalized treatment of acute CVST should be selected in clinical practice. The influencing factors included the clinical manifestations,the degree of occlusion of cerebral vein sinus,and collateral circulation.