血管内介入治疗重症产褥期颅内静脉窦血栓形成  

Endovascular treatment for severe intracranial venous sinus thrombosis in puerperium

作　　者：徐光军[1] 庄献博 姜桂生[1] 苏江利[1] 

机构地区：[1]聊城市人民医院神经内科,山东省252000

出　　处：《中华临床医师杂志（电子版）》2015年第10期86-89,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨上矢状窦远端置管局部溶栓治疗重症产褥期颅内静脉窦血栓形成的疗效和安全性以及抗血小板聚集对预防颅内静脉窦血栓形成复发的安全性、有效性。方法聊城市人民医院神经内科自2008年1月至2013年12月对12例难治性颅内静脉窦血栓形成患者进行了上矢状窦远端置管局部溶栓治疗,辅以机械性血栓切割,以血栓全部或大部分溶解,闭塞的脑静脉窦主干再通为停止溶栓指征。在术后积极治疗原发病及抗血小板聚集治疗6个月。在急性期所有患者给予低分子肝素皮下注射抗凝治疗。术后随访6-70个月,每半年随访1次,包括腰椎穿刺、眼底检查和MRV检查。结果出院时12例患者的颅内压均降至200 mm H2O以下;9例患者闭塞的静脉窦完全再通,动静脉循环时间正常,3例患者闭塞的上矢状窦部分再通,皮层静脉和深静脉予以代偿;11例患者完全恢复,1例患者遗留轻偏瘫,眼底水肿明显减轻或消失,格拉斯哥昏迷量表（GCS）评分由术前平均9.3分恢复到出院时的15分,未出现与血管内治疗相关的并发症。所治疗的12例患者中,在上矢状窦远端置管局部接触性溶栓治疗后,给予氢氯吡格雷和（或）拜阿司匹林抗血小板聚集治疗6个月,无颅内或全身出血并发症发生。本研究随访的患者中最长为70个月,平均随访37.4个月,所有患者中无一例血栓再形成,未出现新的神经功能症状。结论上矢状窦远端置管局部溶栓治疗重症产褥期颅内静脉窦血栓形成是一种安全、有效的治疗方式;静脉侧支循环代偿在疾病恢复过程中起到重要作用;局部溶栓治疗术后给予氢氯吡格雷和（或）拜阿司匹林抗血小板聚集预防产褥期颅内静脉窦血栓形成复发是安全、有效的,抗血小板聚集治疗可能是预防产褥期颅内静脉窦血栓形成复发的有效治疗方法。Objective To explore and evaluate the efficacy and safety of the local thrombolytic therapy in superior sagittal sinus in patients with severe intracranial venous sinus thrombosis during puerperium, as well as the efficacy and safety of anti-platelet aggregation treatment for preventing recurrence of intracranial venous sinus thrombosis. Methods 12 patients during postpartum period with intracranial venous sinus thrombosis received local thrombolytic therapy by placing a microcatheter in the distal end of the superior sagittal sinus during January 2008 to December 2013. All the patients accepted mechanical thrombus maceration before local thrombolytic therapy. All the patients were treated with body weight-adjusted subcutaneous low molecular weight heparin in the acute phase. After stopping local thrombolytic therapy, all 12 patients accepted anti-platelet aggregation treatment for 6 months. Data regarding demographic, clinical and radiological features were collected. Follow-up data were obtained at 6-70 months. DSA or magnetic resonance venography （MRV） was performed to assess the recanalisation of venous sinuses. Results Before discharge, the intracranial pressure in 12 patients was under 200 mmH2O. DSA or MRV confirmed that superior sagittal sinus of 9 patients were smooth. The cortex venous and deep venous recovered to normal. Superior sagittal sinus of 3 patients recanalized partly, and cortex venous and deep venous had compensation. 11 patients had good outcome and 1 patient had only mild deficits. The following-up data obtained during 6 to 70 months＇ observation indicated that no cases of thrombosis formation reoccurred and no new neurological symptoms occurred among all patients. Conclusions Local thrombolysis treatment is safe and effective in patients with severe intracranial venous sinus thrombosis during puerperium in superior sagittal sinus. Collateral circulation compensation play an important role. And it is also safe and effective for patients to be given anti-platelet aggregation treatment

关 键 词：产后期 窦血栓形成 颅内 上矢状窦 溶栓治疗 抗血小板聚集 

分 类 号：R743.3[医药卫生—神经病学与精神病学]