脑静脉窦血栓形成合并脑出血临床分析(附7例报告)

Clinical analysis of cerebral venous sinus thrombosis complicated with cerebral hemorrhage(report of 7 cases)

目的:探讨脑静脉窦血栓合并脑出血的临床诊断和治疗。方法:回顾分析2006年6月～2008年10月收治的7例脑静脉窦血栓合并脑出血患者临床资料。结果:7例患者中,3例入院时已经发生脑疝的患者行开颅血肿清除加去骨瓣减压,术后给予脱水、抗炎治疗,1周后其中2例给予抗凝治疗。4例未发生脑疝患者入院后给予脱水、抗炎、低分子肝素抗凝治疗。1例术后未血凝治疗男性患者半月后并发下肢深静脉血栓家人放弃治疗,自动出院,6例女性患者痊愈出院。结论:抗凝治疗可作为当前治疗脑静脉及脑静脉窦血栓的主要方法,即使在合并颅内出血的情况下,也常作为首选方式,但对于急性颅内高压,在脱水药物治疗无效情况下,手术清除血肿及去骨瓣减压也可作为一种治疗手段。

Objective： To explore the clinical diagnosis and treatment of cerebral venous sinus thrombosis complicated with cerebral hemorrhage. Methods：The clinical data of 7 patients with cerebral venous sinus thrombosis complicated with cerebral hemorrhage enrolled from June 2006 to October 2008 were analyzed retrospectively. Results：Three patients with cerebral herniation on administration accepted hematoma clearance and decompressive eraniectomy, then received dehydration therapy and anti-inflammatory treatment. Two of them received anticoagulant therapy one week later. Four patients without cerebral herniation on administration accepted dehydration, anti-inflammatory treatment and anticoagulant treatment with low molecular weight heparin. Lower limb venous thrombosis occurred a half month later in a male patient who had not accepted anticoagulant therapy. His home members abandoned treatment and discharge automatically. Six female patients recovered and discharged. Conclusion： Anticoagulant therapy could be used as the major treatment for cerebral venous thrombosis and cerebral venous sinus thrombosis. Even when the patient suffered from thrombosis and cranial hemorrhage, it could be the first-line treatment. When the dehydration therapy was ineffective for the acute intracranial hypertension, hematoma clearance and decompressive eraniectomy might be adopted.