發(fā)布時(shí)間：2018-05-18 20:39

  本文選題：腦靜脈系統(tǒng) + 血栓形成　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析腦靜脈系統(tǒng)血栓形成(CVT）的臨床特點(diǎn)及影響預(yù)后的因素。 方法：連續(xù)入組2011年3月至2014年1月廣西壯族自治區(qū)人民醫(yī)院收住的CVT病例，經(jīng)MRV、CTV或DSA確診，接受標(biāo)準(zhǔn)抗凝治療。記錄并分析一般信息、危險(xiǎn)因素、臨床表現(xiàn)、血液和腦脊液檢查結(jié)果、影像特征、3個(gè)月預(yù)后。以NIHSS量化神經(jīng)功能障礙，GCS評(píng)估意識(shí)水平，mRS評(píng)估預(yù)后。應(yīng)用X2檢驗(yàn)或Fisher’s確切概率法對(duì)影響預(yù)后的因素行單因素分析，再把篩選出來p0.05的因素行Logistic回歸多因素分析。 結(jié)果：（1）納入CVT32例，男19例，男:女=1.46:1。年齡14-84歲，平均47.1歲，，＜60歲的青中年23例。（2）男性主要危險(xiǎn)因素為高Hcy血癥（47.4%）、吸煙（36.8%）；61.5%女性發(fā)病與妊娠相關(guān)。（3）亞急性起病65.6%，急性28.1%，慢性6.3%。高顱壓癥狀最多見：頭痛81.3%、惡心/嘔吐31.3%，高顱壓眼底改變31.3%；其次為局灶性神經(jīng)功能受損：癱瘓40.6%、意識(shí)障礙37.5%、失語15.6%、小便失禁15.6%、感覺障礙12.5%、精神行為異常12.5%；癲癇發(fā)作：部分性15.6%，全面性6.3%。青中年組頭痛發(fā)生率高于老年組（95.7%vs44.4%，p=0.003）。上矢狀竇血栓的頭痛發(fā)生率高于非上矢狀竇血栓者（95.0%vs58.3%，p=0.018）；上矢狀竇血栓的癲癇發(fā)生率高于非上矢狀竇血栓者（35.0%vs0.0%，p=0.029）。直竇或Galen靜脈血栓的意識(shí)障礙發(fā)生率高于非直竇或Galen靜脈血栓者（75.0%vs25.0%，p=0.030）。青中年組平均NIHSS評(píng)分低于老年組（3.3±3.7vs10.9±7.9，p=0.020）。（4）影像學(xué)顯示71.9%為多部位腦損傷。靜脈性腦梗死46.9%、腦出血40.6%。血栓部位以上矢狀竇（62.5%）、橫竇（50.0%）、乙狀竇（37.5%）多見；59.4%為多部位血栓。（5）出院后失訪1例。3個(gè)月后mRS0-2分22例；mRS≥3-5分5例，死亡4例。單因素分析顯示，年齡≥60歲、GCS9、NIHSS≥15、腦出血、直竇血栓、血栓部位≥3是預(yù)后不良的危險(xiǎn)因素。多因素分析顯示，年齡≥60歲（OR=8.62,95%CI：1.04-71.76,p=0.046）、GCS9（OR=8.35,95%CI:2.42-59.97, p=0.003）、腦出血（OR=5.01,95%CI:1.98-82.63, p=0.016）是3個(gè)月預(yù)后不良的獨(dú)立危險(xiǎn)因素。 結(jié)論：（1）CVT以青中年為主。高Hcy血癥、吸煙為男性常見危險(xiǎn)因素，女性發(fā)病主要與妊娠相關(guān)。（2）起病方式以亞急性多見。臨床主要表現(xiàn)為高顱壓癥狀、局灶性神經(jīng)功能受損及癲癇，以頭痛最常見。（3）多發(fā)性、跨動(dòng)脈流域性腦梗死或出血是CVT的影像學(xué)特征。最多見的血栓部位是上矢狀竇、橫竇及乙狀竇；血栓常累及多個(gè)部位。（4）CVT總體預(yù)后良好；年齡≥60歲、GCS9、NIHSS≥15、腦出血、直竇血栓、血栓部位≥3預(yù)示3個(gè)月預(yù)后不良；年齡≥60歲、GCS9、腦出血是3個(gè)月預(yù)后不良的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to analyze the clinical features and prognostic factors of cerebral venous thrombosis (CVT). Methods: CVT cases admitted to Guangxi Zhuang Autonomous region people's Hospital from March 2011 to January 2014 were confirmed by MRVV or DSA and received standard anticoagulant therapy. General information, risk factors, clinical manifestations, blood and cerebrospinal fluid findings, imaging features, 3 months prognosis were recorded and analyzed. NIHSS was used to evaluate the level of consciousness and the prognosis of patients with neurological dysfunction. Using X2 test or Fisher's exact probability method, the factors influencing prognosis were analyzed by univariate analysis, and the factors selected from p0.05 were analyzed by Logistic regression multivariate analysis. Results CVT32 included 19 males and 1.46: 1 females. Age 14-84 years (mean 47.1 years, < 60 years old: 23 cases, < 60 years old) the main risk factors of male were hyperHcy and 47.4%. 61.5% of women with smoking and 36.8% had acute onset of subacute disease (65.6%), acute 28.1%, chronic 6.33.The main risk factors were as follows: (1) the main risk factors were: 47.4% of the male patients with hyperthermia, 36.8% of the women with smoking and 36.8% of the women. The most common symptoms of high intracranial pressure were: headache 81.3, nausea / vomiting 31.33.3, cranial pressure changed 31.3; focal nerve function was damaged: paralysis 40.6, consciousness 37.5, aphasia 15.6. urinal incontinence 15.6cm, sensory disturbance 12.5., mental and behavioral abnormality 12.5.; epileptic hair. Work: partly 15.6b, 6.3cm in comprehensiveness. The incidence of headache in the middle-aged group was higher than that in the elderly group (95. 7 vs 44. 4). The incidence of headache in superior sagittal sinus thrombosis was higher than that in patients without superior sagittal sinus thrombosis, and the incidence of epilepsy in superior sagittal sinus thrombosis was higher than that in non-superior sagittal sinus thrombosis patients. The incidence of disturbance of consciousness in patients with venous thrombosis of straight sinus or Galen was higher than that of patients with venous thrombosis of non-straight sinus or Galen (75.0% vs 25.0% vs 0.030%). The average NIHSS score in the young and middle age group was lower than that in the elderly group (3.3 鹵3.7vs10.9 鹵7.9). The imaging findings showed that 71.9% of the patients had multi-site brain injury. Venous cerebral infarction was 46.9 and cerebral hemorrhage was 40.6. Above the thrombus site, 62.5% of the sagittal sinus, 50.0% of the transverse sinus and 37.5% of the sigmoid sinus were found to have multiple sites of thrombus. 1 case was lost after discharge. 3 months later, 22 cases of mRS0-2 score 鈮

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