抗凝与局部溶栓治疗颅内静脉窦血栓形成对比分析

Anticoagulant therapy and local thrombolytic therapy for intracranial venous sinus thrombosis: a comparative analysis of curative effect

目的对比评价单纯抗凝与血管内局部溶栓结合抗凝治疗颅内静脉窦血栓形成(CVST)的效果。方法收集采用单纯抗凝治疗和局部溶栓结合抗凝治疗的CVST患者各30例,单纯抗凝组患者接受皮下注射低分子肝素,后改为口服华法林治疗12个月;局部溶栓结合抗凝组患者分别接受静脉窦内接触性溶栓(18例)、颈内动脉溶栓(6例)、静脉窦内接触性溶栓结合颈内动脉溶栓(6例)治疗,术后常规口服华法林12个月。结果局部溶栓结合抗凝组30例患者静脉窦主干实现再通,有2例窦内接触性溶栓患者出现颅内出血增多并发症;单纯抗凝组27例患者静脉窦主干实现再通,3例患者影像学显示再通不明显,但临床症状改善,无出血并发症。出院前单纯抗凝组患者和局部溶栓结合抗凝组患者Glasgow昏迷量表评分、改良Rankin量表评分分别为13.4±1.6、1.8±0.7和14.2±1.3、1.4±0.7,与治疗前相比差异均有统计学意义(P<0.05)。出院后6、12个月随访时局部溶栓结合抗凝组患者恢复好于单纯抗凝组,单纯抗凝组有2例患者自觉偶发头痛,其中1例为CVST复发。结论局部溶栓结合抗凝治疗CVST是安全有效的,可根据患者具体情况选择不同溶栓治疗手段。

Objective To compare the curative effect of simple anticoagulant therapy with combination use of anticoagulant plus local thrombolytic therapy in treating intracranial venous sinus thrombosis （ICVST）. Methods Thirty ICVST patients receiving simple anticoagulant therapy （control group） and other 30 ICVST patients receiving anticoagulant plus local thrombolytic therapy （study group） were collected. Subcutaneous injection of low molecular weight heparin was employed for the patients of the control group, then, warfarin was orally administered for 12 months. For the patients of the study group, contact thrombolysis in venous sinus （n=18）, or thrombolysis via internal carotid artery （n=6）, or combination use of contact thrombolysis in venous sinus and thrombolysis via internal carotid artery （n=6） was carried out, which was followed by oral taking of warfarin for 12 months. Results In the study group, recanalization of venous sinus trunk was achieved in all 30 patients. Complication of intracranial hemorrhage occurred in 2 patients who received contact thrombolysis in venous sinus. In the control group, recanalization of venous sinus trunk was obtained in 27 patients, but in 3 patients no obvious recanalization of venous sinus trunk was observed although their clinical symptoms were improved and no complication of intracranial hemorrhage was seen. At the time of discharge, Glasgow coma scale score and modified Rankin scale score of the control group were 13.4±1.6 and 1.8±0.7 respectively, while those of the study group were 14.2±1.3 and 1.4±0.7 respectively, the differences between the two groups were statistically significant （P〈0.05）. Follow-up examination at 6 and 12 months after discharge showed that the recovery degree of the study group was better than that of the control group. In the control group two patients complained of occasional headache, among them one patient had recurrence of ICVST. Conclusion For the treatment of ICVST, combination use of anticoagulant therapy and local thrombolytic therapy is safe and effective. Different thrombolytic means can be employed according to the specific circumstances of the patient.