颅内静脉窦血栓形成的临床研究

研究背景颅内静脉窦血栓形成是一种特殊类型的脑血管疾病,其病因及诱发因素复杂多样、临床表现各异,易被误诊或漏诊。该病具有较高的病残率和病死率,如何提高诊断与治疗水平一直是临床研究的热点问题,本文旨在探讨颅内静脉窦血栓形成不同治疗方法的安全性及有效性。方法回顾分析52例颅内静脉窦血栓形成患者的临床资料,并根据临床症状与体征、腰椎穿刺脑脊液压力和影像学表现分为轻症和重症组,分别接受全身抗凝联合静脉溶栓、血管内溶栓或锥颅上矢状窦溶栓治疗,同时辅助华法林口服6～12个月。术后通过磁共振静脉血管造影术观察静脉窦形态。结果轻症组27例患者接受全身抗凝药物联合静脉溶栓治疗,14例痊愈、9例好转、4例无效;重症组25例患者中22例经全身抗凝药物联合血管内溶栓治疗后18例痊愈、3例好转、1例死亡,余3例行锥颅上矢状窦溶栓治疗,均痊愈。共随访6～60个月(平均36个月),无一例复发。结论根据患者病情轻重程度,针对临床分型选择不同方法治疗颅内静脉窦血栓安全有效。

Strategies in the treatment for intracranial venous sinus thrombosis

Background Cerebral venous sinus thrombosis （CVST） is a special type of cerebrovascular disease with high morbidity and mortality which often has an unpredictable outcome. It is usually misdiagnosed because of different causes and variable clinical manifestations. How to improve the diagnosis and therapy of CVST is always the hotspot in clinic. This article aims to investigate the effective and safe strategies in the treatment for CVST. Methods Clinical data of 52 patients diagnosed with CVST were retrospectively analyzed. These patients were subdivided into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. The patients with mild type were treated with systemic anticoagulant therapy combined with intravenous thrombolysis continuous intravenous infusion of heparin （12.50-25） x 103 U/d for 7-10 d followed by a continuous infusion of urokinase （0.50-0.75） x 106 U/d for 5-7 d]. The patients with severe type were treated with endovaseular throlnbolysis injection of urokinase （0.50-1）× 106 U, 0.10 × 106U/rain via carotid or vertebral artery; or intravenous infusion of urokinase 1 x 106 U/d and heparin 25 × 103 U/d for 5-7 d], and superior sagittal sinus cut-open/ intrasinus thrombolysis separately. All the patients took oral warfarin for 6-12 months, and follow-up was performed after operation by the method of magnetic resonance venography （MRV）. Results Among the 27 cases of mild type receiving systemic anticoagulant agents and intravenous thrombolysis, 14 were cured; 9 were improved; 4 were ineffective. Among the 22 cases of severe type receiving systemic anticoagulant drugs and endovaseular thrombo｜ysis, 18 were cured; 3 were improved; 1 was dead. The left 3 cases with gravis type received superior sagitta｜ sinus cut-open/intrasinus thrombolysis and were cured. The period of follow-up was between 6 months and 60 months （the median time was 36 months）, and no recurrence happened. Conclusion It was probable to subdivide CVST into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. Different therapeutic strategies were proved to be safe and effective in the treatment of different types.