颅内静脉系统血栓形成合并脑出血的临床特点、危险因素、诊断方法以及治疗方案分析

目的:探讨颅内静脉系统血栓形成(CVST)合并脑出血的临床特点、危险因素、诊断方法以及治疗方案。方法:选择我院于2002年2月到2017年5月收治的CVST确诊患者38例为研究对象,按照是否合并脑出血分为脑出血组16例与对照组22例,比较两组患者的临床特点、危险因素、诊断方法、治疗方案与预后。结果:脑出血患者MRI显示受累横窦8例、海绵窦6例、乙状窦2例;对照组显示受累横窦10例、海绵窦8例、乙状窦4例。脑出血组的头痛、意识改变、运动障碍等临床症状发生率明显高于对照组(P0.05),两组感觉障碍、视力下降与痫性发作比例对比差异无统计学意义(P0.05)。二分类变量Logistic回归分析显示脑膜炎、贫血、先天性凝血酶原疾病为导致CVST合并脑出血发生的主要独立危险因素(P0.05)。所有患者均给予脱水降颅压及支持对症治疗,脑出血组预后不良8例,不良率为50.0%;对照组预后不良4例,不良率为18.2%,脑出血组的预后不良率明显高于对照组(P0.05)。结论:CVST合并脑出血在临床上比较常见,多表现为头痛、意识改变、运动障碍等,MRI诊断有很好的效果,脑膜炎、贫血、先天性凝血酶原疾病为导致CVST合并脑出血发生的危险因素,抗凝、溶栓等治疗能取得较好的效果。

Clinical Features, Risk Factors, Diagnosis and Treatment of Intracranial Venous Thrombosis Combined with Cerebral Hemorrhage

ABSTRACT Objective: To investigate the clinical features, risk factors, diagnosis and treatment of intracranial venous thrombosis (CVST) combined with cerebral hemorrhage. Methods: 38 cases of CVST patients admitted in our hospital from February 2002 to May 2017 were selected as the research object, all the patients were divided into the cerebral hemorrhage group(16 cases) and control group(22 cases) accorded to whether the patients with cerebral hemorrhage, the clinical features, risk factors, diagnosis, treatment ways and effects were compared between the two groups. Results: In the cerebral hemorrhage group, MRI showed 8 patients of transverse sinus, 6 patients of cavernous sinus and 2 patients of sigmoid sinus, so that were 10 patients, 8 patients and 4 patients in the control group. The headache, altered consciousness, movement disorders in the cerebral hemorrhage group were significantly higher than those of the control group (P<0.05). The sensory dysfunction, decreased visual acuity compared in the two groups showed no significant difference(P>0.05). Two categories of variables Logistic regression analysis showed that meningitis, anemia and congenital prothrombin were the major independent risk factors for CVST combined with intracerebral hemorrhage (P<0.05). All patients were given dehydration to reduce intracranial pressure and symptomatic treatment, there were 8 patients of poor prognosis in the cerebral hemorrhage group, the rate was 50%; so that were 4 patients in the control group, the rate was 18.2%, so the cerebral hemorrhage group was significantly higher than the control group (P<0.05). Conclusion: CVST combined with cerebral hemorrhage is very common in clinical practice, the symptom is more with headache, altered consciousness, movement disorders, MRI diagnosis has good effect, meningitis, anemia and congenital prothrombin are the risk factors with cerebral hemorrhage, anticoagulation and thrombolysis treatment can achieve better results.