99例颅内静脉系统血栓形成的临床分析

发布时间：2018-04-23 03:16

  本文选题：颅内静脉系统血栓形成 + 危险因素　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过探讨颅内静脉系统血栓形成患者的可能的危险因素、临床特点、影像学特征、实验室检查、治疗措施及预后,旨在提高对CVST的认识,使CVST患者能得到尽早诊断及恰当的治疗,改善预后。方法:回顾性分析临床确诊的99例CVST患者的住院病历,详细记录患者的人口统计学数据(性别、年龄)、起病形式、危险因素、首发症状、临床表现、影像学表现、实验室检查、治疗情况及预后,并对上述临床资料进行系统的综合分析和总结。结果:(1)99例CVST患者中男性与女性的比例为1:1.36;(2)患者发病年龄在13~82岁之间,平均年龄为37.59±15.73岁,20~49岁71例(71.72%);(3)急性起病45例(45.46%),亚急性起病44例(44.44%),慢性起病10例(10.10%);(4)颅内压增高71例(71.72%);神经功能缺失症状32例(32.32%);脑病样症状37例(37.37%);(5)79(79.80%)例患者存在多个静脉窦同时受累(≥2个部位),其中横窦68例(68.69%),乙状窦57例(57.58%),上矢状窦56例(56.57%);(6)99例行头CT检查,脑静脉性梗死3例(3.03%),脑实质出血10例(10.10%),蛛网膜下腔出血7例(7.07%),脑实质出血伴梗死2例(2.02%),脑肿胀或脑积水2例(2.02%);93例行头MRI检查,90例行头MRV检查,均在头MRI检查和(或)在头MRV检查中发现异常,MRI主要表现为不同时期的血栓信号以及脑实质病变,MRV主要表现为静脉窦不显影或其管腔内出现不规则充盈缺损;7例行DSA检查,主要表现为窦内管腔变细甚至闭塞,管腔内信号不均;3例行3D VISTA检查,提示有相应部位静脉窦血栓形成;(7)腰穿检查者87例,68例(78.16%)压力高于正常,脑脊液白细胞升高31例(35.63%),蛋白升高36例(41.38%),有红细胞者39例(44.83%),糖、氯化物均正常;50例患者检测了同型半胱氨酸水平,20例(40%)升高;55例患者检测了雌激素水平,10例(18.18%)升高,且均为男性患者;66例患者检测了D-二聚体水平,60例(90.91%)升高;(8)本研究99例患者中,院内治愈51例,有效37例,无效11例。结论:(1)临床上需注意易被忽视的CVST危险因素:高同型半胱氨酸血症、男性患者雌激素升高、低颅压综合征。(2)磁共振VISTA序列是诊断CVST较好的影像学检查手段。(3)D-二聚体检测对CVST诊断具有重要价值。(4)CVST的治疗应采取抗凝、病因及对症支持治疗为主的综合治疗,如果病情恶化,可采取血管内介入治疗。
[Abstract]:Objective: to explore the possible risk factors, clinical features, imaging features, laboratory examination, treatment and prognosis of patients with intracranial venous thrombosis in order to improve the understanding of CVST. So that CVST patients can get early diagnosis and appropriate treatment to improve the prognosis. Methods: the medical records of 99 patients with CVST were retrospectively analyzed. The demographic data (sex, age, onset, risk factors, initial symptoms, clinical manifestations, imaging findings, laboratory examination) were recorded in detail. Treatment and prognosis, and the above-mentioned clinical data were systematically analyzed and summarized. Results the male to female ratio of 99 patients with CVST was 1: 1.36%) the age of onset was between 13 and 82 years old. The mean age was 37.59 卤15.73 years / 2049 years old 71 cases (71.722t) 45 cases with acute onset, 44 cases with subacute onset, 44 cases with subacute onset, 10 cases with chronic onset, 71 cases with increased intracranial pressure (71.722); 32 cases with lack of nerve function (32.32%); 37 cases with encephalopathy like symptoms (37.377,7979.80); The sinus was involved at the same time (鈮，

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