孕产妇颅内静脉窦血栓形成的早期诊断和预防

Early Diagnosis and Prevention of Cerebral Venous Sinus Thrombosis of Pregnant Women

目的 探讨孕产妇颅内静脉窦血栓形成 （cerebral venous sinus thrombosis,CVST）的高危因素及早期诊断和预防.方法 利用维普和中国期刊全文数据库,检索1989至2009年国内文献报道的425例孕产妇颅内静脉窦血栓形成患者的临床资料（住院治疗时间为（1～90）d,平均为24.3 d,按本组患者发病时间, 将其分为孕早期组（n=12,2.82%）,孕中、晚期组（n=90,21.18%）及产后组（n=323,76.00%）[三组患者年龄、住院治疗时间、治疗采取措施及颅内静脉窦血栓形成程度等比较, 差异无显著意义（P＞0.05）].采用统计学方法分析三组患者颅内静脉窦血栓形成的高危因素、临床特点、影像学改变和预后,探讨该病早期诊断和预防措施.结果 425例颅内静脉窦血栓形成孕产妇的高危因素中,以子痫前期、剖宫产术、产后出血最常见;孕早期和孕中、晚期组误诊率分别高达100%和65.63%;产后组误诊率及死亡率分别为 29.80%和 8.63%.CT 检查和 MRI/MRV 检查阳性率分别为54.42%和 94.04%～100.00%.结论 产前和产后2周是孕产妇颅内静脉窦血栓形成高发期.该病产前误诊率极高,孕早期不容忽视.重视高危因素、及早干预是预防该病的关键,对产前疑似患者应尽早进行影像学检查,以明确诊断,早期治疗,减少病死率和致残率.

Objective To investigate high risk factors, early diagnosis and prevention of cerebral venous sinus thrombosis （CVST）. Methods The clinical features of cerebral venous sinus thrombosis as well as imaging examination results of 425 pregnant women with cerebral venous sinus thrombosis （hospitalization time was 1 to 90 days, average hospitalization time was 24. 33 days） were searched from VIP Database and Chinese Journal Full-Text Database （CJFD） from 1989 to 2009. They were divided into three groups according to the onset of cerebral venous sinus thrombosis. There had no statistical significance of age, hospitalization time, treatment measures, and degrees of cerebral venous sinus thrombosis among three groups （P〉0. 05）. High risk factors, clinical features, imaging changes and prognosis of cerebral venous sinus thrombosis were analyzed to discuss the way of early diagnosis and prevention. Results Preeclampsia, cesarean section, postpartum hemorrhage （PPH） were the most common risk factors of cerebral venous sinus thrombosis of pregnant women. The misdiagnosis rates of cerebral venous sinus thrombosis in early, middle and late pregnancy were 100.00% and 65.63%, respectively. The postpartum misdiagnosis rate and mortality were 29. 8% and 8. 6%, respectively. The positive rates of graphical changes were 54.42% and 94.04%-100% by CT and MRI/MRV inspection, respectively. Conclusion Prepregnancy and two weeks after delivery are susceptible to cerebral venous sinus thrombosis compared with other periods. Misdiagnosis rate is extremely high during early pregnancy, which can not be ignored. The key to prevent cerebral venous sinus thrombosis are early intervention and more attention to high risk factors. The suspected patients in prenatal and labor stage should undergo MRV inspection in order to confirm the diagnosis, conduct early treatment to reduce mortality and disability.