本文選題：顱內(nèi)深靜脈系統(tǒng)血栓形成 + 低分子肝素��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：[研究背景與目的] 顱內(nèi)靜脈系統(tǒng)血栓形成(cerebral venous thrombosis, CVT)是由多種原因?qū)е碌哪X靜脈回流受阻的一組特殊類型的腦血管病,約占所有腦血管病的0.5%～1.0%,病因復(fù)雜,發(fā)病形式多樣,臨床表現(xiàn)無特異性,診斷困難。其中,顱內(nèi)深靜脈系統(tǒng)血栓形成(deep cerebral venous thrombosis, DCVT)更是罕見,即使積極給予抗凝等治療,部分患者也會(huì)出現(xiàn)病情進(jìn)展,病情危重,死亡率、致殘率高,目前針對DCVT的研究遠(yuǎn)遠(yuǎn)不足。因此,我們報(bào)告一例重癥DCVT病例,并結(jié)合文獻(xiàn)對其臨床特點(diǎn)進(jìn)行總結(jié),以加深臨床工作者的認(rèn)識(shí),提高早期發(fā)現(xiàn)和診斷率,以期改善患者預(yù)后。 [研究方法] (1)報(bào)告并分析山東大學(xué)齊魯醫(yī)院神經(jīng)內(nèi)科收治的一例重型DCVT病例,詳細(xì)記錄其病因、臨床表現(xiàn)、實(shí)驗(yàn)室檢查、影像學(xué)檢查、使用的新型抗凝治療方案及隨訪情況。 (2)對相關(guān)期刊論文(CNKI)和萬方數(shù)據(jù)庫收錄的,有關(guān)DCVT的病例報(bào)告及研究進(jìn)行回顧性分析,總結(jié)DCVT的臨床特點(diǎn)。 [結(jié)果] (1)病例報(bào)告：患者,女,49歲,農(nóng)民,因“頭痛伴惡心、嘔吐2天,嗜睡1天”于2013-8-19入院。綜合病因、臨床表現(xiàn)、影像學(xué)所見,診斷為DCVT,大腦大靜脈、大腦大靜脈、直竇受累�；颊咴趩为�(dú)使用低分子肝素抗凝過程中,病情持續(xù)惡化,并出現(xiàn)昏迷、顳葉鉤回疝、出血性腦梗塞,死亡或殘障風(fēng)險(xiǎn)高。聯(lián)合使用利伐沙班和低分子肝素抗凝治療,8周后改為單純口服利伐沙班治療,患者癥狀明顯改善,4個(gè)月時(shí)隨訪MRI、MRV顯示栓塞的靜脈、靜脈竇完全再通,隨訪7個(gè)月未觀察到顱內(nèi)或全身的血栓事件,患者最終僅遺留輕度認(rèn)知減退。 (2)文獻(xiàn)復(fù)習(xí)：報(bào)告病例121例,男性43例(35.5%),女性78例(64.5%),平均發(fā)病年齡33.2歲；85例中,產(chǎn)褥期24例(28.2%),感染14例(16.5%),口服避孕藥7例(8.2%),妊娠5例(5.9%),脫水5例(5.9%),原因不明17例(20.0%)；108例患者中,表現(xiàn)為顱內(nèi)壓升高的癥狀、體征者79例(73.1%),意識(shí)障礙50例(46.3%),錐體系表現(xiàn)者44例(40.7%),抽搐28例(25.9%),腦膜刺激征20例(18.5%),去腦強(qiáng)直10例(9.3%),高熱5例(4.6%)；42例患者有腰椎穿刺術(shù)記錄,其中40例顱內(nèi)壓高于20OmmH2O。所有患者的影像學(xué)檢查都見到相應(yīng)區(qū)域的腦水腫,25例(20.7%)出現(xiàn)靜脈性梗塞,其中21例為出血性梗塞；3例(2.5%)患者發(fā)現(xiàn)顱內(nèi)出血。有受累靜脈(竇)描述的112例患者中,23例(20.5%)僅深靜脈系統(tǒng)受累,57例(50.9%)患者除深靜脈外,尚有一個(gè)及以上靜脈竇受累。 [結(jié)論] (1)利伐沙班聯(lián)合低分子肝素抗凝治療,在此例DCVT患者效果及安全性良好,此新型抗凝治療方法用于DCVT的治療尚屬國內(nèi)外首例報(bào)告,但一例應(yīng)用不足以說明該治療方法的確切效果,其安全性和療效尚需大規(guī)模的基礎(chǔ)和臨床隨機(jī)對照試驗(yàn)進(jìn)一步驗(yàn)證。 (2)DCVT任何年齡均可發(fā)病,以青年患者,特別是女性多見；其病因及危險(xiǎn)因素與靜脈竇血栓形成類似,常同時(shí)累及直竇和(或)橫竇,出血性梗塞更為常見。但考慮到發(fā)表偏倚,結(jié)果尚需進(jìn)一步研究驗(yàn)證。
[Abstract]:[research background and purpose]
Cerebral venous thrombosis (CVT) is a special group of cerebrovascular diseases caused by a variety of causes of cerebral venous reflux, which accounts for about 0.5% to 1% of all cerebrovascular diseases. The cause of the disease is complex, the form of the disease is varied, the clinical manifestations are not specific and the diagnosis is difficult. Among them, the thrombosis of the deep venous system of the intracranial (D Eep cerebral venous thrombosis, DCVT) is more rare. Even if anticoagulant therapy is actively given, some patients will also have progress, critical condition, death rate, high disability rate, and far insufficient research on DCVT. Therefore, we report a case of severe DCVT and summarize the clinical features in combination with the literature to deepen the clinical practice. The understanding of workers can improve the early detection and diagnosis rate in order to improve the prognosis of patients.
[research methods]
(1) a case of severe DCVT was reported and analyzed in the Department of Neurology of Qilu Hospital of Shandong University. The cause, clinical manifestation, laboratory examination, imaging examination, new anticoagulant therapy and follow-up were recorded in detail.
(2) a retrospective analysis of the case reports and studies on DCVT collected from the Chinese journal full text database (CNKI) and Wanfang database, and the clinical characteristics of DCVT were summarized.
[results]
(1) case report: a patient, a woman, 49 years old, a farmer, admitted to 2013-8-19 for "headache, nausea, vomiting 2 days, sleepiness, 1 days". Comprehensive etiology, clinical manifestations, imaging findings, diagnosis of DCVT, large cerebral veins, large cerebral veins, and straight sinus involvement. Patients have continued to deteriorate in the process of anticoagulation with low molecular weight heparin alone, and appear coma, temporomandibular Leaf hook back hernia, hemorrhagic cerebral infarction, high risk of death or disability. Combined use of Lev Shaaban and low molecular weight heparin anticoagulant therapy, 8 weeks later, the patients were changed to simple oral Lev Shaaban treatment, the patient's symptoms were obviously improved, the follow-up was 4 months at MRI, the venous sinus of the embolic and the venous sinus was completely recanalization, and the intracranial or systemic thrombus was not observed for 7 months. In the event, the patient ended up with only mild cognitive impairment.
(2) literature review: 121 cases of reported cases, 43 men (35.5%), 78 women (64.5%), average age of 33.2 years; 85 cases, 24 cases (28.2%), 14 cases of infection, 7 cases of oral contraceptives, pregnancies, dehydration cases, symptoms and signs of elevated intracranial pressure 79 cases (73.1%), 50 cases of consciousness disorder (46.3%), 44 cases of conical system (40.7%), 28 cases of convulsions (25.9%), 20 cases of meningeal irritation (18.5%), 10 cases of cerebral ankylosis (9.3%) and high fever 5 cases (4.6%). (20.7%) there were venous infarction, of which 21 were hemorrhagic infarcts; 3 cases (2.5%) found intracranial hemorrhage. Of the 112 patients with the involved veins (sinus), 23 (20.5%) had only deep venous system, and 57 (50.9%) had more than one or more venous sinus involvement except the deep veins.
[Conclusion]
(1) Lev Shaaban combined with low molecular weight heparin anticoagulant therapy, in this case, the effect and safety of DCVT patients is good. The new anticoagulant therapy for DCVT is the first report at home and abroad, but one case is not sufficient to explain the exact effect of the treatment. The safety and efficacy of this new method still need a large scale of basic and clinical randomized controlled trial. Further verification.
(2) DCVT can occur at any age and is common in young patients, especially women; its etiology and risk factors are similar to venous sinus thrombosis, often involving direct sinus and / or transverse sinus. Hemorrhagic infarction is more common.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王桂芝,呂洋,王永珍*,陳樹新*;成人腦深靜脈系統(tǒng)血栓MRI表現(xiàn)[J];白求恩醫(yī)科大學(xué)學(xué)報(bào);2000年05期

2 程少容;王鷹;陽昱恒;孫志強(qiáng);田龍海;羅金香;陳信堅(jiān);;4D-CTA技術(shù)在腦動(dòng)靜脈畸形診斷中的應(yīng)用價(jià)值[J];功能與分子醫(yī)學(xué)影像學(xué)(電子版);2012年01期

3 車軍;崔瑛;吳浩;吉訓(xùn)明;;靜脈竇血栓形成急性期機(jī)械碎栓聯(lián)合藥物溶栓治療3例[J];神經(jīng)疾病與精神衛(wèi)生;2007年06期

4 孫淑霞;朱金生;谷艷英;徐克;;腦深靜脈血栓的MRI診斷[J];臨床放射學(xué)雜志;2010年07期

5 高傳生;腦深靜脈血栓和上矢狀竇血栓形成1例報(bào)告[J];臨床神經(jīng)病學(xué)雜志;2003年04期

6 張昱,吳江,劉群,王守春,馬滌輝;Galen靜脈血栓13例臨床分析[J];中華老年心腦血管病雜志;2000年06期

7 王守春,劉群,張昱,唐立冬,李長順;Galen靜脈血栓(附6例報(bào)告)[J];腦與神經(jīng)疾病雜志;1998年03期

8 陳正挪;許若峰;程國勤;;大腦深靜脈血栓形成7例臨床與MR[J];腦與神經(jīng)疾病雜志;2006年04期

9 李廣文;曾現(xiàn)偉;季泰令;李思頡;凌鋒;吉訓(xùn)明;;抗凝與血管內(nèi)機(jī)械碎栓治療顱內(nèi)靜脈竇血栓形成的療效觀察[J];中國腦血管病雜志;2012年12期

10 李愛靜;楊光釗;潘宇寧;;4D-CTA在腦動(dòng)靜脈畸形診斷中的價(jià)值[J];臨床放射學(xué)雜志;2013年04期

，

本文編號(hào)：1790761