颅内静脉窦血栓形成的临床特点分析

发布时间：2018-02-25 02:20

本文关键词： 缺血性脑血管病抗凝溶栓治疗　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景和目的颅内静脉窦血栓形成(cerebral veneous sinus thrombosis, CVST)是以静脉窦血栓形成导致静脉窦腔闭塞、狭窄,从而引起脑静脉回流受阻继而产生一系列病理生理改变的一类疾病的统称,是由于多种感染性或非感染性因素导致的脑静脉或静脉窦内血栓形成,导致脑静脉血回流受阻,静脉血瘀滞,造成脑组织水肿引起颅内压增高。研究发现,CVST发病原因与感染、恶性肿瘤、自身免疫性疾病、妊娠、产褥及口服避孕药等因素有关。CVST发病率相对较低,大约为3-4/100万人,在所有脑卒中患者中仅占1%的比例,并且临床表现无明显特异性,因此临床工作中易被忽视,造成误诊、误治。本研究通过对45例CVST患者临床资料进行回顾分析,总结CVST的高危因素、发病原因、临床诊断及治疗、预后的特点,提高临床工作中对CVST的诊断、治疗能力。方法郑州大学第二临床学院与新乡医学院附属医院自2006.1至2013.12收治CVST患者45例,回顾性分析这45例CVST患者的病史、临床表现、影像学、治疗方法、预后及随访资料,总结其发病高危因素、发病原因、临床症状体征、影像学表现、静脉窦栓塞部位、实验室检查结果、治疗方法及预后等方面的特点。结果 45例CVST患者,男性18例,女性27例,男女比例约为1：1.5,最小年龄8岁,最大年龄83岁,平均41±5.13岁。急性起病16例(35.6%),亚急性起病22例(48.9%),慢性起病7例(11.1%)。所有患者中38例(84.4%)存在目前已知的一种或多种危险因素,7例未发现明确的危险因素,其中存在两种以上的危险因素的14例(31.1%)。病因明确的患者中非感染性占65.8%、感染性占34.2%。45例患者中以头痛为首发症状患者28例占62.2%,以局灶神经症状起病7例,以癫痫发作起病4例,以意识障碍起病3例,以复视、精神异常、肢体瘫痪各1例。影像学检查显示病变累及两个以上静脉窦33例,占总例数的73.33%,31例累及上矢状窦(68.89%),24例累及横窦(53.33%),12例累及乙状窦(26.67%),9例累及直窦(20.00%),5例累及窦汇(11.11%),1例累及海绵窦(2.22%)。.45例患者中12例治愈,30例病情好转,3例病情恶化。通过对治疗前后mRS评分的比较,静脉内溶栓治疗组效果优于单纯抗凝组及全身抗凝联合降纤治疗,差异有统计学意义。结论 1.CVST青壮年发病率较高,起病形式多样,常呈亚急性起病或急性起病,女性患者多于男性患者。 2.非感染性因素在CVST的发病中有较高比重,应当引起足够的重视。 3.头痛为CVST患者最常见的首发症状和临床症状。 4.CVST的血栓常为多发性的,上矢状窦、横窦、乙状窦为好发部位。 5.CVST一旦确诊应尽早治疗,静脉内溶栓治疗的效果可能优于单纯抗凝及抗凝联合降纤治疗。
[Abstract]:Background and purpose. Cerebral veneous sinus thrombosis (CVSTs) is a kind of disease which is caused by venous sinus thrombosis, which leads to the occlusion and stenosis of venous sinus cavity, which results in the obstruction of cerebral venous reflux and a series of pathophysiological changes. It is caused by a variety of infectious or non-infectious factors, such as thrombosis in cerebral vein or sinus, which leads to the obstruction of venous blood flow, the stagnation of venous blood, and the increase of intracranial pressure caused by edema of brain tissue. It is found that CVST is the cause and infection of CVST. Cancer, autoimmune diseases, pregnancy, puerperal and oral contraceptives, etc. The incidence of CVST is relatively low, about 3 to 4 / 1 million people, accounting for only 1% of all stroke patients, and the clinical manifestations are not specific. Therefore, it is easy to be neglected in clinical work, resulting in misdiagnosis and mistreatment. Through retrospective analysis of clinical data of 45 patients with CVST, the high risk factors, causes, clinical diagnosis, treatment and prognosis of CVST were summarized. To improve the ability of diagnosis and treatment of CVST in clinical work. Method. Forty-five patients with CVST were treated in the affiliated Hospital of the second Clinical College of Zhengzhou University and the affiliated Hospital of Xinxiang Medical College from June 2006 to December 2013.The history, clinical manifestation, imaging, treatment methods, prognosis and follow-up data of 45 patients with CVST were retrospectively analyzed. The characteristics of high risk factors, causes, clinical symptoms and signs, imaging manifestations, location of venous sinus embolism, laboratory examination results, treatment methods and prognosis were summarized. Results. Forty-five patients with CVST, 18 males and 27 females, had a ratio of about 1: 1.5, the youngest age was 8 years, the maximum age was 83 years. The mean age was 41 卤5.13 years. There were 16 cases with acute onset, 22 cases with subacute onset, 48.9 cases with subacute onset, 7 cases with chronic onset and 7 cases with chronic onset. Among all the patients, 38 cases had one or more known risk factors and 7 cases had no definite risk factors. Among them, there were 14 cases with more than two risk factors. Non-infectious diseases accounted for 65.8%, infectious symptoms accounted for 34.2.45 cases, headache was the first symptom in 28 cases (62.2%), focal neurological symptoms (7 cases) and seizures (4 cases). There were 3 cases with disturbance of consciousness, 1 case with diplopia, 1 case with mental abnormality and 1 case with limb paralysis. Imaging examination showed that the lesions involved more than two venous sinuses in 33 cases. Of the total number of cases, 73.3333 / 31 involved the superior sagittal sinus (68.89) and 24 cases involved the transverse sinus (53.33). 12 cases involved the sigmoid sinus gyrus 26.67 (9 cases) and the straight sinus (20.00%) in 5 cases (11.1111%). Among the 45 cases, 30 cases were cured and 30 cases improved and 3 cases deteriorated. Comparison of mRS scores before and after treatment, The effect of intravenous thrombolytic therapy group was better than that of simple anticoagulant group and systemic anticoagulant combined with defibrillation group, the difference was statistically significant. Conclusion. 1. The incidence of CVST in young adults was high, and the incidence of CVST was various. The incidence of subacute or acute onset was more common in female than in male. 2. Non-infectious factors have a high proportion in the pathogenesis of CVST and should be paid more attention to. 3. Headache is the most common initial symptom and clinical symptom in CVST patients. 4. The thrombus of CVST is often multiple. The superior sagittal sinus, transverse sinus and sigmoid sinus are the most common sites. 5. Once CVST is diagnosed, the effect of intravenous thrombolytic therapy may be better than that of anticoagulant and anticoagulant combined with defibrillation therapy.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】