机械取栓术联合抗凝治疗脑静脉窦血栓形成合并出血患者疗效观察

Therapeutic effect of mechanical thrombectomy combined with systemic anticoagulation on patients with cerebral venous sinus thrombosis and hemorrhage

目的初步观察机械取栓术联合抗凝治疗对脑静脉窦血栓形成（CVST）合并出血患者的治疗效果。方法比较15例CVST合并出血的患者在联合静脉窦取栓术和抗凝治疗前后头痛程度、格拉斯哥昏迷量表（GCS）评分及改良Rankin评分的差异,观察患者的治疗效果及存在的手术并发症。结果 1例患者病情危重,术中因脑疝死亡。其余14例患者在联合静脉窦取栓术和抗凝治疗后临床症状明显减轻。头痛的程度、GCS评分及改良Rankin评分在治疗前后比较差异均有统计学意义（P〈0.05）。14例患者均无手术并发症发生。随访3个月后,14例患者改良Rankin评分0~2。结论对CVST合并有出血的患者,可考虑及早行机械取栓术联合抗凝治疗,以促进神经功能尽早恢复。

Objective To investigate the therapeutic effects of mechanical thrombectomy combined with systemic anticoagulation on patients with cerebral venous sinus thrombosis（ CVST） and hemorrhage. Methods Fifteen patients with CVST and hemorrhage were treated with mechanical thrombectomy and systemic anticoagulation. The differences of headache degree,score of Glasgow coma scale and modified Rankin scale were compared before and after treatment. The surgery-related complications and therapeutic effect were also observed. Results One case was very serious and died from cerebral hernia during surgery. For the other 14 cases,the clinical symptoms were improved after given mechanical thrombectomy combined with systemic anticoagulation. There were significant differences in headache degree,score of Glasgow coma scale and modified Rankin scale before and after treatment in the 14 cases（ P〈0. 05）. And no surgery-related complication occurred. The score of modified Rankin scale in the 14 cases was 0- 2 after follow-up for three-month. Conclusion Mechanical thrombectomy combined with systemic anticoagulation is feasible in patients with CVST and hemorrhage,which may result in rapid neurological and symptomatic improvement.