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目的对比评价单纯抗凝与血管内局部溶栓结合抗凝治疗颅内静脉窦血栓形成(CVST)的效果。方法收集采用单纯抗凝治疗和局部溶栓结合抗凝治疗的CVST患者各30例,单纯抗凝组患者接受皮下注射低分子肝素,后改为口服华法林治疗12个月;局部溶栓结合抗凝组患者分别接受静脉窦内接触性溶栓(18例)、颈内动脉溶栓(6例)、静脉窦内接触性溶栓结合颈内动脉溶栓(6例)治疗,术后常规口服华法林12个月。结果局部溶栓结合抗凝组30例患者静脉窦主干实现再通,有2例窦内接触性溶栓患者出现颅内出血增多并发症;单纯抗凝组27例患者静脉窦主干实现再通,3例患者影像学显示再通不明显,但临床症状改善,无出血并发症。出院前单纯抗凝组患者和局部溶栓结合抗凝组患者Glasgow昏迷量表评分、改良Rankin量表评分分别为13.4±1.6、1.8±0.7和14.2±1.3、1.4±0.7,与治疗前相比差异均有统计学意义(P<0.05)。出院后6、12个月随访时局部溶栓结合抗凝组患者恢复好于单纯抗凝组,单纯抗凝组有2例患者自觉偶发头痛,其中1例为CVST复发。结论局部溶栓结合抗凝治疗CVST是安全有效的,可根据患者具体情况选择不同溶栓治疗手段。
Objective To compare the effects of simple anticoagulation with intravascular thrombolysis combined with anticoagulation in the treatment of intracranial venous sinus thrombosis (CVST). Methods Thirty patients with CVST were treated with anticoagulant anticoagulation combined with local thrombolytic therapy and local anticoagulation respectively. Patients in the anticoagulation group received low molecular weight heparin subcutaneously and then received oral warfarin for 12 months. Local thrombolysis Patients in the anticoagulation group received intra-sinus contact thrombolysis (18 cases), internal carotid artery thrombolysis (6 cases), sinus venous sinus thrombolysis combined with internal carotid artery thrombolysis (6 cases), postoperative routine Warfarin orally 12 months. Results Thirty patients with local thrombolysis and anticoagulation achieved recanalization of the sinus trunk, and two cases of intracranial hemorrhage with intracranial sinus thrombosis occurred complications. In the anticoagulation group, 27 cases of sinus trunk were recanalized and 3 The patient’s imaging showed recanalization is not obvious, but the clinical symptoms improved, no bleeding complications. Glasgow coma scale and modified Rankin scale scores of patients with simple anticoagulation before discharge and patients with local thrombolysis and anticoagulation were 13.4 ± 1.6,1.8 ± 0.7 and 14.2 ± 1.3,1.4 ± 0.7, respectively The differences were statistically significant (P <0.05). Patients who underwent local thrombolysis combined with anticoagulation at 6 and 12 months after discharge returned better than those who received anticoagulation alone. Two patients spontaneously developed spontaneous headache in the anticoagulation group, of which 1 was CVST. Conclusion Local thrombolysis combined with anticoagulant therapy is a safe and effective treatment of CVST, according to the specific circumstances of patients choose different thrombolytic therapy.