妊娠早期合并颅内静脉窦血栓11例临床分析

Clinical analysis of intracranial venous sinus thrombosis in first trimester pregnancy of 11 patients

目的探讨妊娠早期合并颅内静脉窦血栓(CVST)形成的特点、诊断、治疗以及临床结局。方法回顾性分析首都医科大学宣武医院2015年12月至2019年12月围产期CVST患者的临床资料及随访资料。结果此时间段围产期合并CVST患者共39例,其中妊娠早期合并CVST 11例(28.21%)。妊娠早期11例中,初产妇3例,经产妇8例,发病年龄22~42岁;临床表现以头痛(10例)、癫痫发作(5例)、意识障碍(3例)、肢体无力(5例)最为常见。核磁共振成像提示血栓形成部位常见于上矢状窦(8例)、横窦(9例)和乙状窦(9例),绝大多数患者(10例)累及多个静脉窦。妊娠期合并CVST首选低分子肝素钠抗凝治疗,8例单纯抗凝治疗有效,3例需介入治疗;2例妊娠至孕足月分娩,9例选择终止妊娠;10例痊愈,1例残存左侧肢体功能障碍。结论妊娠早期合并CVST虽是罕见的脑血管病,临床表现缺乏特异性,但若早期发现、早期诊断、早期处理,仍可获得良好的临床预后。

Objective To investigate the clinical characteristics,diagnosis,treatment and outcome of cerebral venous sinus thrombosis(CVST)in first trimester pregnancy.Methods A retrospective analysis was performed on the data of patients with CVST during the perinatal period admitted to Xuanwu Hospital of Capital Medical University from December 2015 to December 2019.Results There were 39 cases of perinatal CVST,including 11 cases in first trimester pregnancy(28.21%).Among the 11 cases of CVST in early pregnancy,there were 3 primiparas and 8 multiparas with 22-42 years old.Headache(10 cases),epilepsy(5 cases),disturbance of consciousness(3 cases)and limb weakness(5 cases)were the most common clinical manifestations.Magnetic resonance imaging revealed superior sagittal sinus thrombosis in 8 cases,transverse sinus in 9 cases,sigmoid sinus in 9 cases and multiple venous sinuses thrombosis in the majority of patients(10 cases).Low molecular weight heparin sodium anticoagulant therapy was the first choice for the patients,with 8 patients receiving effective anticoagulant therapy alone and 3 patients requiring interventional therapy;there were 2 cases of full-term delivery and 9 cases of choosing to terminate pregnancy;10 cases were cured,and 1 case had residual left limb dysfunction.Conclusion CVST in first trimester pregnancy is a rare cerebrovascular disease with no specific clinical manifestations,but a good clinical outcome can be obtained if it is found,diagnosed and treated early.