全身抗凝联合血管内介入多种方式治疗颅内静脉窦血栓的疗效

发布时间：2018-03-23 11:22

本文选题：颅内静脉窦血栓　切入点：介入治疗　出处：《中国脑血管病杂志》2017年11期

【摘要】：目的探讨使用全身抗凝联合血管内介入多种方式治疗颅内静脉窦血栓的疗效。方法回顾性分析河北医科大学第二医院神经内科2014年5月至2017年1月经DSA确诊的颅内静脉窦血栓52例患者的临床资料,均接受动脉内微导管溶栓治疗。留置微导管3~14 d,尿激酶用量1万~2万U/h,13例加用球囊扩张,1例加用支架辅助治疗。分析影像学资料及6个月电话随访结果。以改良Rankin量表(mRS)和美国国立卫生研究院卒中量表(NIHSS)评价预后。结果 52例患者入院全脑DSA示上矢状窦血栓34例、横窦-乙状窦移形区血栓31例、下矢状窦血栓2例、直窦血栓3例、皮质静脉血栓14例。出院前复查造影示静脉窦完全通畅9例,大部分通畅42例,部分通畅1例,出院时症状减轻、神经功能评分好转48例,无明显变化3例,加重1例。对治疗前后mRS及NIHSS评分进行比较,差异有统计学意义(Z值分别为5.45、3.03,均P0.05)。6个月电话随访48例患者未出现静脉窦血栓相关症状,3例患者死亡,1例患者因外伤致颅内出血死亡。结论血管内介入治疗颅内静脉窦血栓安全有效,可作为内科抗凝无效患者的备选治疗方案。
[Abstract]:Objective to evaluate the efficacy of systemic anticoagulant therapy combined with intravascular intervention in the treatment of intracranial venous sinus thrombosis. Methods the cranium diagnosed by DSA from May 2014 to January 2017 in Department of Neurology, second Hospital of Hebei Medical University was retrospectively analyzed. Clinical data of 52 patients with internal venous sinus thrombosis, All patients were treated with intraarterial microcatheter thrombolytic therapy. 13 patients with urokinase were treated with balloon dilatation in 13 patients with urokinase for 14 days. The imaging data were analyzed and the results of 6 months telephone follow-up were analyzed. Rankin and NIHSS were used to evaluate the prognosis. Results 52 patients were admitted to the hospital and 34 patients were diagnosed as superior sagittal sinus thrombosis by DSA. There were 31 cases of transverse sinus-sigmoid sinus thrombosis, 2 cases of inferior sagittal sinus thrombosis, 3 cases of straight sinus thrombosis, 14 cases of cortical vein thrombosis. The symptoms were relieved, the neurological function scores were improved in 48 cases, no obvious changes were found in 3 cases, and 1 case was aggravated. The scores of mRS and NIHSS before and after treatment were compared. The difference of Z value was 5.45 卤3.03, all of which were P0.050.After 6 months of telephone follow-up, 48 patients without venous sinus thrombotic symptoms and 3 patients died, and 1 patient died of traumatic intracranial hemorrhage. Conclusion Intracranial interventional therapy can cause intracranial hemorrhage. Venous sinus thrombosis is safe and effective. It can be used as an alternative therapy for patients with ineffective anticoagulant therapy.
【作者单位】：河北医科大学第二医院神经内科;
【分类号】：R743

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