抗凝与血管内机械碎栓治疗颅内静脉窦血栓形成的疗效观察  

Clinical observation of anticoagulation and endovascular mechanical thrombectomy in the treatment of cerebral venous sinus thrombosis

作　　者：李广文[1,2] 曾现伟[2] 季泰令[2] 李思颉[1] 凌锋[1] 吉训明[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]潍坊医学院附属医院神经外科,261061

出　　处：《中国脑血管病杂志》2012年第12期625-628,672,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：“十一五”国家科技支撑计划项目(2011BAI08B07)

摘　　要：目的对比血管内机械碎栓与单纯抗凝治疗脑静脉窦血栓形成(CVST)的安全性和有效性。方法收集临床上诊断明确的CVST患者137例,其中采用单纯抗凝治疗的有75例(皮下注射低分子肝素0.4 ml,2次/d,病情稳定后改为口服华法林,12个月),机械碎栓治疗的62例(其中40例联合接触性溶栓治疗。术后药物治疗同抗凝组)。比较两组的疗效及安全性。结果①治疗前机械碎栓组有神经功能缺损、癫痫发作、嗜睡或昏迷、伴出血或梗死的患者均多于单纯抗凝组,改良Rankin量表评分(mRS)高于单纯抗凝组[(3.1±1.0)分,(2.1±0.8)分]。均P<0.05。②治疗后,两组临床症状均好转。出院前机械碎栓组mRS低于单纯抗凝组[(1.1±0.4)分,(1.6±0.3)分],P<0.05。出院时抗凝组中18例(24.0%)颅内压仍然增高,其中10例(13.3%)存在视盘水肿;机械碎栓组有12例(19.4%)存在颅内压增高,8例(12.9%)有视盘水肿,P>0.05。③两组各死亡1例。机械碎栓组有4例术前脑出血的患者,治疗后血肿增大,3例症状加重,其中1例因脑疝形成拒绝手术而死亡。④抗凝组62例、机械碎栓组56例获得1～5年的随访。单纯抗凝组有6例(因未规范口服抗凝药),机械碎栓组中有4例仍有颅内压增高症状。继续抗凝后好转。结论机械碎栓组患者临床症状比单纯抗凝组重,但临床预后优于单纯抗凝组。Objective To compare the safety and efficacy of endovascular mechanical thrombectomy and anticoagulation alone in the treatment of cerebral venous sinus thrombosis （CVST）. Methods A to-tal of 137 patients with CVST were enrolled in this study,among them,75 patients were treated with （low molecular weight heparin 0.4 mL injection, twice a day, for 3 to 23 days, then oral warfarin for 12 months. 62 patients were treated with mechani thrombectomy. 40 of them were treated in combination with contact thrombolytic therapy. Postoperative drug treatment was the same as the anticoagulation alone group. The safety and efficacy of both groups were compared. Results ①Before treatment, the patients with neuro-logical deficit, status epilepticus seizures, drowsiness/coma, and hemorrhage/infarction in the mechanical thrombectomy group were more than those in the anticoagulation alone group. The modified Rankin scale （mRS） score was higher than that in the antieoagulation alone group （3.1 ± 1.0 vs. 2.1 ±0.8; all P 〈 0. 05）. ②After treatment, the clinical symptoms were improved in the patients of both groups. Before discharge, the mRS score in the mechanical thrombectomy group was lower than that in the antieoagulation alone group （ 1.1 ± 0.4 vs. 1.6 ± 0.3 ; P 〈 0.05 ）. Eighteen patients （ 24.0% ） in the anticoagulation alone group still had increased intracranial pressure, and 10 of them （13.3%） had optic disc edema; 12 patients （19. 4% ） in mechanical thrombectomy group had increased intracranial pressure, and 8 （ 12.9% ） had optic disc edema （P 〉 0.05）. ③Onc patient died in each group. There were 4 patients with intracerebral hemorrhage in the mechanical thrombectomy group before procedure, and their hematmna enlarged and symptoms got worse. One of them died of brain herniation because of refusing surgery. ④62 patients in the anticoagulation alone group and 56 in the mechanical thrombectomy group were fol-lowed up for 1 to 5 years. Six patients in the anticoagulation alon

关 键 词：窦血栓形成 颅内 抗凝 机械碎栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]