全身抗凝联合血管内治疗颅内静脉窦血栓形成的临床效果观察

Efficacy of systemic anticoagulation combined with endovascular treatment for cerebral venous sinus thrombosis

摘要:

目的 对全身抗凝联合血管内治疗在颅内静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）中的临床治疗效果进行观察评估。方法 回顾性纳入2008年6月至2021年8月于海军军医大学第一附属医院接受治疗的CVST患者，根据治疗方式不同分为抗凝治疗（anticoagulation treatment，AT）组和血管内治疗（endovascular treatment，EVT）组，分析2组患者的临床资料及治疗效果。结果 共纳入54例患者，其中AT组27例，EVT组27例。EVT组血栓累及上矢状窦和直窦的患者比例、累及静脉窦数量、入院改良Rankin量表（modified Rankin scale，mRS）评分明显高于AT组（P<0.05）。治疗后2组患者凝血酶原时间、活化部分凝血酶时间较治疗前均明显延长，AT组D-二聚体水平较治疗前明显下降（P<0.05）。EVT组治疗后血管再通率明显高于AT组（P<0.05），总住院时间、重症监护室入住时间、并发症发生率、生存情况以及神经功能预后均与AT组无统计学差异（P>0.05）。2组患者治疗后mRS评分均较治疗前明显下降（P<0.05）。结论 对于血栓累及广泛、全身抗凝疗效不佳的重症CVST患者，在标准抗凝的基础上联合血管内治疗可作为一种安全有效的潜在治疗方案。

Abstract:

Objective To observe and evaluate the clinical efficacy of systemic anticoagulation combined with endovascular treatment of cerebral venous sinus thrombosis（CVST）.Methods CVST patients who were treated in our hospital from June 2008 to August 2021 were retrospectively enrolled，and divided into anticoagulation treatment（AT）group and endovascular treatment（EVT）group according to different treatment methods. Additionally，the clinical data and treatment effects of the two groups were analyzed.Results A total of 54 patients were enrolled, including 27 patients in the AT group and 27 patients in the EVT group. Compared with the AT group, the proportion of patients with thrombosis involving superior sagittal sinus and straight sinus, amount of involved sinus and modified Rankin scale (mRS) scores of patients were significantly higher in EVT group（P<0.05）. After treatment，prothrombin time and activated partial thrombin time in two groups were significantly increased，and the level of D-dimer in AT group was significantly reduced（P<0.05）. The recanalization rate of the EVT group was significantly higher than that of the AT group（P<0.05），and there were no significant differences in total duration of hospital stay，duration of ICU stays，incidence of complications，survival rate and neurological prognosis between the EVT group and the AT group（P>0.05）. The mRS scores of patients after treatment were significantly lower than those before treatment in both groups（P<0.05）.Conclusion For severe CVST patients with extensive thrombus involvement and poor anticoagulant efficacy，standard anticoagulant therapy combined with endovascular treatment could be a safe and effective potential option.