颅内深静脉系统血栓形成一例报告并文献复习

发布时间：2018-04-23 06:09

本文选题：颅内深静脉系统血栓形成 + 低分子肝素　；参考：《山东大学》2014年硕士论文

【摘要】：[研究背景与目的] 颅内静脉系统血栓形成(cerebral venous thrombosis, CVT)是由多种原因导致的脑静脉回流受阻的一组特殊类型的脑血管病,约占所有脑血管病的0.5%～1.0%,病因复杂,发病形式多样,临床表现无特异性,诊断困难。其中,颅内深静脉系统血栓形成(deep cerebral venous thrombosis, DCVT)更是罕见,即使积极给予抗凝等治疗,部分患者也会出现病情进展,病情危重,死亡率、致残率高,目前针对DCVT的研究远远不足。因此,我们报告一例重症DCVT病例,并结合文献对其临床特点进行总结,以加深临床工作者的认识,提高早期发现和诊断率,以期改善患者预后。 [研究方法] (1)报告并分析山东大学齐鲁医院神经内科收治的一例重型DCVT病例,详细记录其病因、临床表现、实验室检查、影像学检查、使用的新型抗凝治疗方案及随访情况。 (2)对相关期刊论文(CNKI)和万方数据库收录的,有关DCVT的病例报告及研究进行回顾性分析,总结DCVT的临床特点。 [结果] (1)病例报告：患者,女,49岁,农民,因“头痛伴恶心、呕吐2天,嗜睡1天”于2013-8-19入院。综合病因、临床表现、影像学所见,诊断为DCVT,大脑大静脉、大脑大静脉、直窦受累。患者在单独使用低分子肝素抗凝过程中,病情持续恶化,并出现昏迷、颞叶钩回疝、出血性脑梗塞,死亡或残障风险高。联合使用利伐沙班和低分子肝素抗凝治疗,8周后改为单纯口服利伐沙班治疗,患者症状明显改善,4个月时随访MRI、MRV显示栓塞的静脉、静脉窦完全再通,随访7个月未观察到颅内或全身的血栓事件,患者最终仅遗留轻度认知减退。 (2)文献复习：报告病例121例,男性43例(35.5%),女性78例(64.5%),平均发病年龄33.2岁；85例中,产褥期24例(28.2%),感染14例(16.5%),口服避孕药7例(8.2%),妊娠5例(5.9%),脱水5例(5.9%),原因不明17例(20.0%)；108例患者中,表现为颅内压升高的症状、体征者79例(73.1%),意识障碍50例(46.3%),锥体系表现者44例(40.7%),抽搐28例(25.9%),脑膜刺激征20例(18.5%),去脑强直10例(9.3%),高热5例(4.6%)；42例患者有腰椎穿刺术记录,其中40例颅内压高于20OmmH2O。所有患者的影像学检查都见到相应区域的脑水肿,25例(20.7%)出现静脉性梗塞,其中21例为出血性梗塞；3例(2.5%)患者发现颅内出血。有受累静脉(窦)描述的112例患者中,23例(20.5%)仅深静脉系统受累,57例(50.9%)患者除深静脉外,尚有一个及以上静脉窦受累。 [结论] (1)利伐沙班联合低分子肝素抗凝治疗,在此例DCVT患者效果及安全性良好,此新型抗凝治疗方法用于DCVT的治疗尚属国内外首例报告,但一例应用不足以说明该治疗方法的确切效果,其安全性和疗效尚需大规模的基础和临床随机对照试验进一步验证。 (2)DCVT任何年龄均可发病,以青年患者,特别是女性多见；其病因及危险因素与静脉窦血栓形成类似,常同时累及直窦和(或)横窦,出血性梗塞更为常见。但考虑到发表偏倚,结果尚需进一步研究验证。
[Abstract]:[research background and purpose]
Cerebral venous thrombosis (CVT) is a special group of cerebrovascular diseases caused by a variety of causes of cerebral venous reflux, which accounts for about 0.5% to 1% of all cerebrovascular diseases. The cause of the disease is complex, the form of the disease is varied, the clinical manifestations are not specific and the diagnosis is difficult. Among them, the thrombosis of the deep venous system of the intracranial (D Eep cerebral venous thrombosis, DCVT) is more rare. Even if anticoagulant therapy is actively given, some patients will also have progress, critical condition, death rate, high disability rate, and far insufficient research on DCVT. Therefore, we report a case of severe DCVT and summarize the clinical features in combination with the literature to deepen the clinical practice. The understanding of workers can improve the early detection and diagnosis rate in order to improve the prognosis of patients.
[research methods]
(1) a case of severe DCVT was reported and analyzed in the Department of Neurology of Qilu Hospital of Shandong University. The cause, clinical manifestation, laboratory examination, imaging examination, new anticoagulant therapy and follow-up were recorded in detail.
(2) a retrospective analysis of the case reports and studies on DCVT collected from the Chinese journal full text database (CNKI) and Wanfang database, and the clinical characteristics of DCVT were summarized.
[results]
(1) case report: a patient, a woman, 49 years old, a farmer, admitted to 2013-8-19 for "headache, nausea, vomiting 2 days, sleepiness, 1 days". Comprehensive etiology, clinical manifestations, imaging findings, diagnosis of DCVT, large cerebral veins, large cerebral veins, and straight sinus involvement. Patients have continued to deteriorate in the process of anticoagulation with low molecular weight heparin alone, and appear coma, temporomandibular Leaf hook back hernia, hemorrhagic cerebral infarction, high risk of death or disability. Combined use of Lev Shaaban and low molecular weight heparin anticoagulant therapy, 8 weeks later, the patients were changed to simple oral Lev Shaaban treatment, the patient's symptoms were obviously improved, the follow-up was 4 months at MRI, the venous sinus of the embolic and the venous sinus was completely recanalization, and the intracranial or systemic thrombus was not observed for 7 months. In the event, the patient ended up with only mild cognitive impairment.
(2) literature review: 121 cases of reported cases, 43 men (35.5%), 78 women (64.5%), average age of 33.2 years; 85 cases, 24 cases (28.2%), 14 cases of infection, 7 cases of oral contraceptives, pregnancies, dehydration cases, symptoms and signs of elevated intracranial pressure 79 cases (73.1%), 50 cases of consciousness disorder (46.3%), 44 cases of conical system (40.7%), 28 cases of convulsions (25.9%), 20 cases of meningeal irritation (18.5%), 10 cases of cerebral ankylosis (9.3%) and high fever 5 cases (4.6%). (20.7%) there were venous infarction, of which 21 were hemorrhagic infarcts; 3 cases (2.5%) found intracranial hemorrhage. Of the 112 patients with the involved veins (sinus), 23 (20.5%) had only deep venous system, and 57 (50.9%) had more than one or more venous sinus involvement except the deep veins.
[Conclusion]
(1) Lev Shaaban combined with low molecular weight heparin anticoagulant therapy, in this case, the effect and safety of DCVT patients is good. The new anticoagulant therapy for DCVT is the first report at home and abroad, but one case is not sufficient to explain the exact effect of the treatment. The safety and efficacy of this new method still need a large scale of basic and clinical randomized controlled trial. Further verification.
(2) DCVT can occur at any age and is common in young patients, especially women; its etiology and risk factors are similar to venous sinus thrombosis, often involving direct sinus and / or transverse sinus. Hemorrhagic infarction is more common.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

【参考文献】