孕产妇颅内静脉窦血栓形成26例临床分析

目的探讨孕产妇颅内静脉窦血栓形成(CVST)的高危因素、临床特点、诊治及预防。方法回顾性分析1997年1月至2007年12月南方医科大学南方医院26例孕产妇CVST患者的临床资料。结果26例患者危险因素以剖宫产术、长期卧床、子前期为主;孕早期7例占26.9%,孕中期2例占7.7%,孕晚期3例占11.5%,产褥期14例占53.8%,以上矢状窦区病灶多见。主要临床表现为头痛;影像学检查为主要诊断方法;以首选抗凝的综合治疗为原则,其显效率61.5%,病死率11.5%,误诊率高达57.7%。结论CVST临床表现缺乏特异性,高危因素众多,误诊率高,确诊有赖于影像学检查,综合治疗为原则,抗凝治疗安全有效,重在预防。

Clinical analysis of 26 cases of cerebral venous sinus thrombosis in pregnant women and parturient

Objective To investigate the clinical characteristics,inducing risk factors,diagnosis,treatment and preventive measures of cerebral venous sinus thrombosis(CVST).Methods We performed a retrospective review based on the clinical data of pregnant women and parturients(n=26) who suffered from CVST from Jan.1997 to Dec.2007 in Nanfang Hospital,Southern Medical University.Results Cesarean section,long-term keeping in bed and pre-eclampsia were the most common risk factors for CVST.The risk was higher in the first trimester than in the second and third trimester.The most common site of CVST was the superior sagittal sinus.Headache was the major clinical manifestations.The diagnosis depended on image analysis.Comprehensive treatment based on anticoagulation management was performed,and the rate of efficiency,mortality and misdiagnosis was 61.5%,11.5% and 57.7% respectively.Conclusion There are multiple risk-factors for CVST;it has no specific clinical feature but has a high rate of misdiagnosis.Neuroimaging examination acts as a key role in the final diagnosis.Therapeutic principle is comprehensive treatment.Anticoagulation is a safe and effective therapy.Preventive measures are very important.