肾病综合征并发颅内静脉窦血栓五例

Nephrotic syndrome complicated with intracranial venous thrombosis treated with urokinase：Report of 5 cases

目的 探讨肾病综合征患儿并发颅内静脉窦血栓的诊断,及应用尿激酶与低分子肝素等联合治疗效果.方法 采用尿激酶与低分子肝素等联合治疗.（1）尿激酶：初剂量2000～4000 U/（kg·d）,首剂冲击量20 000～40 000 U在15～30 min内滴完,而后将余量用输液泵均匀地泵入,第2天起2000 U/（kg·d）用输液泵均匀地泵入,1个疗程3～7 d.治疗期间每周测定3次凝血酶时间（TT）、激活的部分凝血致活酶时间（APTT）,应控制TT和APTT应小于2倍延长的范围内,特别注意有无出血情况.（2）低分子肝素：每次100～120 AXaIU/kg,每天1～2次,腹部皮下注射,2周1疗程.（3）抗血小板凝聚药物：长期口服双嘧达莫3～5 mg/（kg·d）,每天2～3次,疗程3个月.结果 5例肾病综合征并发颅内静脉窦血栓,经过尿激酶、低分子肝素与双嘧达莫等联合治疗,1个月后患儿临床症状均消失;复查血浆黏度1个月恢复正常,部分凝血活酶时间、血浆凝血酶原时间、纤维蛋白原降解产物1～2个月后恢复至正常,头颅CT或MRI检查1～3个月后静脉血栓消失,示颅内静脉窦血栓完全再通;随访无复发病例.结论 早期应用尿激酶抗纤溶、低分子肝紊抗凝及抗血小板凝聚药物综合治疗,其溶栓疗效较好.对儿童肾病综合征并发颅内静脉窦血栓的早期诊断与防治具有一定的推广价值.

Objective To explore the effect of urokinase and low molecular weight heparin in children with nephrotic syndrome complicated with intracranial venous thrombosis. Methods Urokinase and low molecular weight heparin were administered to the 5 patients intravenously. The initial dose of urokinase was 2000-4000 U/（kg·d）, the initial pulse dose was 20 000-40 000 U given within 15-30 minutes, and the left was infused by using a pump, from the second day 2000 U/（kg·d） urokinase was infused daily for 3 to 7 days. During the treatment thrombin time （TT）, activated partial thromboplastin time （APTT） were tested 3 times every week, with particular attention to bleeding. Low molecular weight heparin 100-120 AXaIU/kg, 1 or 2 times per day was hypodermally injected for a course of two weeks. Anti-platelet drugs： long-term oral administration of dipyridamole 3-5 mg/（kg·d） was applied 2-3 times every day for 3 months. Results The clinical symptoms disappeared after one month of the combined therapy of urokinase, low molecular weight heparin and dipyridamoh in 5 eases of nephrotic syndrome complicated with intracranial venous thrombosis in children, the plasma viscosity returned to normal in 1 month, activated partial thromboplustin time, prothrombin time, fibrinogen degradation products returned to normal in 1 to 2 months , venous thrombosis disappeared after 1 to 3 months in head CT or MRI examination, showing the cerebral venous sinus thrombosis complete recanalization without relapse cases in follow-up. Conclusion The early application of urokinase and low molecular heparin and anti-platelet coagulation drugs was effectiw The early diagnosis, treatment and prevention of intracranial vein thrombosis in patients with nephrotic syndrome is important.