全身抗凝联合血管内介入多种方式治疗颅内静脉窦血栓的疗效  

Efficacy of systemic anticoagulation combined with endovascular interventional therapy for cerebral venous sinus throm bosis

作　　者：赵鹏浩 周存河[1] 于江华[1] 苏旭东[1] 王姣 刘增品[1] 

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《中国脑血管病杂志》2017年第11期594-598,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨使用全身抗凝联合血管内介入多种方式治疗颅内静脉窦血栓的疗效。方法回顾性分析河北医科大学第二医院神经内科2014年5月至2017年1月经DSA确诊的颅内静脉窦血栓52例患者的临床资料,均接受动脉内微导管溶栓治疗。留置微导管3~14 d,尿激酶用量1万~2万U/h,13例加用球囊扩张,1例加用支架辅助治疗。分析影像学资料及6个月电话随访结果。以改良Rankin量表(mRS)和美国国立卫生研究院卒中量表(NIHSS)评价预后。结果 52例患者入院全脑DSA示上矢状窦血栓34例、横窦-乙状窦移形区血栓31例、下矢状窦血栓2例、直窦血栓3例、皮质静脉血栓14例。出院前复查造影示静脉窦完全通畅9例,大部分通畅42例,部分通畅1例,出院时症状减轻、神经功能评分好转48例,无明显变化3例,加重1例。对治疗前后mRS及NIHSS评分进行比较,差异有统计学意义(Z值分别为5.45、3.03,均P<0.05)。6个月电话随访48例患者未出现静脉窦血栓相关症状,3例患者死亡,1例患者因外伤致颅内出血死亡。结论血管内介入治疗颅内静脉窦血栓安全有效,可作为内科抗凝无效患者的备选治疗方案。Objective To investigate the efficacy of treatment of intracranial venous sinus thrombosis using systemic anticoagulation combined with endovascular intervention. Methods From May 2014 to January 2017,the clinical data of 52 patients with cerebral venous sinus thrombosis diagnosed with DSA and treated with micro catheter thrombolysis at the Department of Neurology,the Second Hospital of Hebei Medical University were analyzed retrospective. The microcatheters were indwelled for 3-14 d. The dosage of urokinase ranged from 10-20 thousand U/h,13 patients were also treated with balloon dilatation,and 1 was also treated with stent-assisted treatment. The results of imaging data and 6-month telephone follow-up were analyzed. The prognosis was evaluated with the modified Rankin scale（ mRS） and National Institutes of Health Stroke Scale（ NIHSS）. Results In 52 patients admitted to hospital,the whole brain DSA showed sagittal sinus thrombosis in 34 cases,transverse-sigmoid sinus transitional zone thrombosis in 31 cases,inferior sagittal sinus thrombosis in 2 cases,straight sinus thrombosis in 3 cases,and cortical vein thrombosis in 14 cases. Angiography before discharge showed complete patency of the venous sinus in 9 cases,most patency in 42 cases,partial patency in 1 cases,the symptoms were relieved,and neurological function scores were improved at discharge in 48 cases. There were no obvious changes in 3 cases,and 1 case aggravated.The mRS and NIHSS scores before and after treatment were compared. The difference was statistically significant（ Z = 5. 45 and 3. 03 respectively,all P 0. 05）. Forty-eight patients were followed up for 6 months by telephone,no symptoms related to venous sinus thrombosis were found. Three patients died,and 1 died of traumatic intracranial hemorrhage. Conclusions Endovascular intervention is an effective and safe treatment for intracranial venous sinus thrombosis. It can be used as an alternative treatment scheme of internal medicine for patients of ineffective anticoagulation.

关 键 词：颅内静脉窦血栓 介入治疗 尿激酶 抗凝 

分 类 号：R743[医药卫生—神经病学与精神病学]