改良溶栓方案联合全身抗凝治疗脑静脉窦血栓形成的临床研究

Clinical efficacy of improved thrombolytic regimen combined with systemic anticoagulation for cerebral venous sinus thrombosis

目的研究改良溶栓方案联合全身抗凝治疗脑静脉窦血栓形成（cVST）的临床有效性和安全性。方法选择CVST患者57例，根据治疗方式不同分为单纯抗凝组（34例）和联合组（z3例）。单纯抗凝组在常规治疗基础上均给予低分子量肝素抗凝治疗；联合组在上述治疗基础上，给予改良溶栓方案（即静脉窦内持续微量接触性溶栓）介入治疗。比较两组患者神经功能缺损评分、治疗后残疾程度、血管再通率和不良反应发生情况。结果联合组接受接触性溶栓治疗2～8d，尿激酶应用总量26万～384万U。联合组治疗后神经功能改善明显（z=-1．725，P=0．048）。通过mRS评分来评价治疗后患者的残疾程度，单纯抗凝组完全恢复、部分恢复、残疾和死亡例数分别为19、6、6和3例，而联合组分别为20、2、1和0例，联合组mRS评分明显低于单纯抗凝组（z=-1．894，P=0．043）。联合组16例通过治疗后进行造影复查，完全再通者7例，部分再通者9例；单纯抗凝组19例行磁共振静脉血管成像复查，完全再通者3例，部分再通者15例，无明显变化者1例。联合组血栓再通率明显高于单纯抗凝组（z=-2．126，P=0．024）。联合组不良反应发生率高于单纯抗凝组[30．4％（7，23）比5．9％（2，34）]（r=17．432，P〈0．01）。而两组颅内出血发生率比较差异无统计学意义（z=-0．766，P=0．157）。结论改良溶栓治疗方案更适用于病程相对较短的，特别是急性发病的CVST患者，可有效改善患者神经功能缺失症状，提高临床疗效。

Objective To study the clinical efficacy and safety of improved thrombolytie regimen combined with systemic anticoagulation therapy for cerebral venous sinus thrombosis （CVST）. Methods Fifty-seven patients with CVST were divided into anticoagulation group （34 cases） and combined thrombolysis group （23 cases） according to different treatment. On the basis of conventional therapy, patients in anticoagnlation group were given low molecular weight heparin anticoagulant therapy; while patients in combined thrombolysis group were given improved thrombolytic interventional treatment program. Neurological deficit scores, the degree of disability, the recanalization rate and adverse reaction rate after treatment of two groups were compared. Results Cases in combined thrombolysis group received thrombolytic therapy for 2 -8 d,and urokinase total application was 26 million -384 million U. Nerve function in combined thrombolysis group improved significantly compared with that in anticoagulation group after treatment （Z =-1.725, P = 0.048）. The degree of disability after treatment was assessed by menopause rating scale （mRS） scores. The number of fully restored, partially restored, disability and death in antieoagulation group was 19, 6, 6 and 3 cases, respectively, while in combined thrombolysis group was 20, 2, 1 and 0 case. The degree of disability in combined thrombolysis group after treatment was significantlylower than that in anticoagulation group （Z = -1.894,P = 0.043 ）. Sixteen patients in combined thrombolysis group underwent angiography after treament, among whom complete recanalization occurred in 7 cases, and partial recanalization in 9 cases. Magnetic resonance imaging on veins review was done in 19 cases in anticoagulation group, among whom complete recanalization occurred in 3 cases, partial recanalization in 15 patients ,and no significant change in 1 case. Thrombus recanalization rate in combined thrombolysis group was significantly higher than that in anticoagulantion group （Z= -2.126, P= 0.024）. Incidence of adverse reactions was higher than that in anticoagulation group [30.4%（7/23 ） vs. 5.9%（2/34） ] （ 2z = 17.432, P 〈 0.01 ）. The incidence of intracranial hemorrhage of the two groups had no significant difference （Z = -0.766, P = 0.157）. Conclusion The improved thrombolytic therapy program is more suitable for patients of a relatively short duration, especially with acute onset of CVST, which can effectively improve neurological function in patients and improve clinical outcomes.