本文關(guān)鍵詞： 缺血性腦血管病 抗凝溶栓治療　出處：《鄭州大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景和目的 顱內(nèi)靜脈竇血栓形成(cerebral veneous sinus thrombosis, CVST)是以靜脈竇血栓形成導(dǎo)致靜脈竇腔閉塞、狹窄,從而引起腦靜脈回流受阻繼而產(chǎn)生一系列病理生理改變的一類(lèi)疾病的統(tǒng)稱(chēng),是由于多種感染性或非感染性因素導(dǎo)致的腦靜脈或靜脈竇內(nèi)血栓形成,導(dǎo)致腦靜脈血回流受阻,靜脈血瘀滯,造成腦組織水腫引起顱內(nèi)壓增高。研究發(fā)現(xiàn),CVST發(fā)病原因與感染、惡性腫瘤、自身免疫性疾病、妊娠、產(chǎn)褥及口服避孕藥等因素有關(guān)。CVST發(fā)病率相對(duì)較低,大約為3-4/100萬(wàn)人,在所有腦卒中患者中僅占1%的比例,并且臨床表現(xiàn)無(wú)明顯特異性,因此臨床工作中易被忽視,造成誤診、誤治。本研究通過(guò)對(duì)45例CVST患者臨床資料進(jìn)行回顧分析,總結(jié)CVST的高危因素、發(fā)病原因、臨床診斷及治療、預(yù)后的特點(diǎn),提高臨床工作中對(duì)CVST的診斷、治療能力。 方法 鄭州大學(xué)第二臨床學(xué)院與新鄉(xiāng)醫(yī)學(xué)院附屬醫(yī)院自2006.1至2013.12收治CVST患者45例,回顧性分析這45例CVST患者的病史、臨床表現(xiàn)、影像學(xué)、治療方法、預(yù)后及隨訪資料,總結(jié)其發(fā)病高危因素、發(fā)病原因、臨床癥狀體征、影像學(xué)表現(xiàn)、靜脈竇栓塞部位、實(shí)驗(yàn)室檢查結(jié)果、治療方法及預(yù)后等方面的特點(diǎn)。 結(jié)果 45例CVST患者,男性18例,女性27例,男女比例約為1：1.5,最小年齡8歲,最大年齡83歲,平均41±5.13歲。急性起病16例(35.6%),亞急性起病22例(48.9%),慢性起病7例(11.1%)。所有患者中38例(84.4%)存在目前已知的一種或多種危險(xiǎn)因素,7例未發(fā)現(xiàn)明確的危險(xiǎn)因素,其中存在兩種以上的危險(xiǎn)因素的14例(31.1%)。病因明確的患者中非感染性占65.8%、感染性占34.2%。45例患者中以頭痛為首發(fā)癥狀患者28例占62.2%,以局灶神經(jīng)癥狀起病7例,以癲癇發(fā)作起病4例,以意識(shí)障礙起病3例,以復(fù)視、精神異常、肢體癱瘓各1例。影像學(xué)檢查顯示病變累及兩個(gè)以上靜脈竇33例,占總例數(shù)的73.33%,31例累及上矢狀竇(68.89%),24例累及橫竇(53.33%),12例累及乙狀竇(26.67%),9例累及直竇(20.00%),5例累及竇匯(11.11%),1例累及海綿竇(2.22%)。.45例患者中12例治愈,30例病情好轉(zhuǎn),3例病情惡化。通過(guò)對(duì)治療前后mRS評(píng)分的比較,靜脈內(nèi)溶栓治療組效果優(yōu)于單純抗凝組及全身抗凝聯(lián)合降纖治療,差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論 1.CVST青壯年發(fā)病率較高,起病形式多樣,常呈亞急性起病或急性起病,女性患者多于男性患者。 2.非感染性因素在CVST的發(fā)病中有較高比重,應(yīng)當(dāng)引起足夠的重視。 3.頭痛為CVST患者最常見(jiàn)的首發(fā)癥狀和臨床癥狀。 4.CVST的血栓常為多發(fā)性的,上矢狀竇、橫竇、乙狀竇為好發(fā)部位。 5.CVST一旦確診應(yīng)盡早治療,靜脈內(nèi)溶栓治療的效果可能優(yōu)于單純抗凝及抗凝聯(lián)合降纖治療。
[Abstract]:Background and purpose. Cerebral veneous sinus thrombosis (CVSTs) is a kind of disease which is caused by venous sinus thrombosis, which leads to the occlusion and stenosis of venous sinus cavity, which results in the obstruction of cerebral venous reflux and a series of pathophysiological changes. It is caused by a variety of infectious or non-infectious factors, such as thrombosis in cerebral vein or sinus, which leads to the obstruction of venous blood flow, the stagnation of venous blood, and the increase of intracranial pressure caused by edema of brain tissue. It is found that CVST is the cause and infection of CVST. Cancer, autoimmune diseases, pregnancy, puerperal and oral contraceptives, etc. The incidence of CVST is relatively low, about 3 to 4 / 1 million people, accounting for only 1% of all stroke patients, and the clinical manifestations are not specific. Therefore, it is easy to be neglected in clinical work, resulting in misdiagnosis and mistreatment. Through retrospective analysis of clinical data of 45 patients with CVST, the high risk factors, causes, clinical diagnosis, treatment and prognosis of CVST were summarized. To improve the ability of diagnosis and treatment of CVST in clinical work. Method. Forty-five patients with CVST were treated in the affiliated Hospital of the second Clinical College of Zhengzhou University and the affiliated Hospital of Xinxiang Medical College from June 2006 to December 2013.The history, clinical manifestation, imaging, treatment methods, prognosis and follow-up data of 45 patients with CVST were retrospectively analyzed. The characteristics of high risk factors, causes, clinical symptoms and signs, imaging manifestations, location of venous sinus embolism, laboratory examination results, treatment methods and prognosis were summarized. Results. Forty-five patients with CVST, 18 males and 27 females, had a ratio of about 1: 1.5, the youngest age was 8 years, the maximum age was 83 years. The mean age was 41 鹵5.13 years. There were 16 cases with acute onset, 22 cases with subacute onset, 48.9 cases with subacute onset, 7 cases with chronic onset and 7 cases with chronic onset. Among all the patients, 38 cases had one or more known risk factors and 7 cases had no definite risk factors. Among them, there were 14 cases with more than two risk factors. Non-infectious diseases accounted for 65.8%, infectious symptoms accounted for 34.2.45 cases, headache was the first symptom in 28 cases (62.2%), focal neurological symptoms (7 cases) and seizures (4 cases). There were 3 cases with disturbance of consciousness, 1 case with diplopia, 1 case with mental abnormality and 1 case with limb paralysis. Imaging examination showed that the lesions involved more than two venous sinuses in 33 cases. Of the total number of cases, 73.3333 / 31 involved the superior sagittal sinus (68.89) and 24 cases involved the transverse sinus (53.33). 12 cases involved the sigmoid sinus gyrus 26.67 (9 cases) and the straight sinus (20.00%) in 5 cases (11.1111%). Among the 45 cases, 30 cases were cured and 30 cases improved and 3 cases deteriorated. Comparison of mRS scores before and after treatment, The effect of intravenous thrombolytic therapy group was better than that of simple anticoagulant group and systemic anticoagulant combined with defibrillation group, the difference was statistically significant. Conclusion. 1. The incidence of CVST in young adults was high, and the incidence of CVST was various. The incidence of subacute or acute onset was more common in female than in male. 2. Non-infectious factors have a high proportion in the pathogenesis of CVST and should be paid more attention to. 3. Headache is the most common initial symptom and clinical symptom in CVST patients. 4. The thrombus of CVST is often multiple. The superior sagittal sinus, transverse sinus and sigmoid sinus are the most common sites. 5. Once CVST is diagnosed, the effect of intravenous thrombolytic therapy may be better than that of anticoagulant and anticoagulant combined with defibrillation therapy.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3

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