105例脑静脉及静脉窦血栓的临床分析

发布时间：2018-06-08 22:51

本文选题：静脉窦血栓 + 诊断　；参考：《浙江大学》2014年硕士论文

【摘要】：目的探讨脑静脉及静脉窦血栓(CVST)的临床特征,以提高对CVST的认识和诊断水平。方法回顾性分析经影像学确诊的105例CVST患者的临床资料,男57例,女48例,对患者的发病年龄、危险因素、临床表现、实验室检查、影像学表现、治疗及预后进行分析。结果①患者年龄多在21-50岁,平均年龄为38.35±15.76岁,男性与女性发病年龄无显著性差异(p0.05)；②多数患者为急性起病；③头痛为最常见表现,其他主要表现为呕吐、癫痫发作、局灶性神经功能缺损,严重者可以出现意识障碍；④男性患者最常见的危险因素为血栓形成倾向(35.42%)和感染因素(26.32%),女性患者最常见的危险因素为产褥期(20.83%)和贫血(20.83%)。⑤病变部位主要为横窦(73例),其次乙状窦(57例)、上矢状窦(52例),52例患者存在多个静脉窦同时受累(3个部位)。影像学表现为脑静脉和/或静脉窦血栓或闭塞(100%),局限性梗死灶15例,出血或血肿29例,脑实质明显水肿20例,合并蛛网膜下腔出血19例；⑥63例(87.50%)患者脑脊液压力升高明显,白细胞及蛋白含量无明显特异性；⑦应用抗凝、脱水、病因治疗及对症支持治疗,105例患者中92人好转,11人病情加重、自动出院或死亡,2例拒绝进一步治疗并出院,预后不详。⑧不良院内预后的预测因子包括意识障碍(OR6.16,95%CI1.66-22.82, p0.05)、初测脑脊液压力400mmH2O(OR5.31,95%CI1.14-24.72, p0.05),影像见明显水肿(OR6.69,95%CI1.79-24.93,p0.05)。结论静脉窦血栓患者发病较年轻,表现无特异性,对临床急性起病的头痛、呕吐、伴或不伴局灶性神经功能缺损及癫痫发作的中青年患者,应高度怀疑CVST,建议行MRI/MRV检查以明确诊断。多种危险因素可引起,部分患者病因不能明确,男性与女性患者在形成CVST血栓危险因素方面有较大区别。大部分患者行抗凝为主的综合治疗预后良好；重症患者病情进展快、致死率高,预后差,影响预后的因素包括意识障碍、初测脑脊液压力400mmH2O、影像见明显水肿。
[Abstract]:Objective to investigate the clinical features of cerebral vein and venous sinus thrombosis (CVST) in order to improve the understanding and diagnosis of CVST. Methods the clinical data of 105 patients with CVST confirmed by imaging were analyzed retrospectively, including 57 males and 48 females. Risk factors, clinical manifestations, laboratory examination, imaging findings, treatment and prognosis were analyzed. Results 1 the age of the patients was 21 to 50 years old, with an average age of 38. 35 卤15. 76 years. There was no significant difference in onset age between male and female. Most of the patients had the most common symptoms of acute onset headache. The other main manifestations were vomiting, seizure, focal nerve function defect, and consciousness disorder in severe cases. 4The most common risk factors in male patients were thrombus formation tendency (35.42) and infective factors (26.32%). The most common risk factors in female patients were puerperium (20.833g) and anemia (20.83.5%) in 73 cases of transverse sinus, 57 cases of sigmoid sinus gyrus (57 cases). In 52 patients with sagittal sinus, 52 patients had multiple venous sinus involvement (3 sites). The imaging manifestations included cerebral vein and / or venous sinus thrombosis or occlusion, focal infarction in 15 cases, hemorrhage or hematoma in 29 cases, cerebral parenchyma edema in 20 cases, and subarachnoid hemorrhage in 19 cases (663 cases). White blood cell and protein contents were not specifically used in 105 patients with anticoagulant, dehydration, etiological treatment and symptomatic support therapy. Among 105 patients, 92 patients had improved and 11 patients had been aggravated, 2 patients who were discharged automatically or died refused further treatment and were discharged from hospital. The prognostic factors of adverse nosocomial prognosis include consciousness disorder OR6.16995, CI 1.66-22.82, p0.05, cerebrospinal fluid pressure 400mm H _ 2O OR 5.31 ~ 95CI1.14-24.72, p0.05N, p0.050.Conclusion the patients with venous sinus thrombosis are younger, have no specificity and have a headache for clinical acute disease. Young and middle-aged patients with vomiting, with or without focal neurological deficits and seizures should be highly suspicious of CVST.MRV MRV should be performed to confirm the diagnosis. Multiple risk factors may be caused, some patients are not clear etiology, men and women in the formation of CVST thrombosis risk factors have greater differences. Most of the patients were treated with anticoagulant therapy with good prognosis, severe patients had rapid progression, high mortality and poor prognosis. The factors influencing prognosis included disturbance of consciousness, initial measurement of cerebrospinal fluid pressure of 400mm H _ 2O, and obvious edema on images.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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