早、中期妊娠合并颅内静脉窦血栓形成10例临床处理分析

摘要

目的:探讨早、中期妊娠合并颅内静脉窦血栓形成患者的治疗及终止妊娠的临床处理.方法:回顾性分析我院2000 ～2011年收治的10例孕早期(8例)和孕中期(2例)妊娠合并颅内静脉窦血栓患者的临床资料.结果:伴意识障碍、脑血管造影明确为静脉窦血栓6例患者(孕早期4例,孕中期2例),行股静脉或颈静脉入路药物局部溶栓及机械联合溶栓和碎栓治疗.其中孕早期2例结合静脉窦成形术,1例孕早期及1例孕中期术后还保留微导管.6例患者中5例术后2～7天神智转清,临床症状明显改善,其中1例孕早期术后1天自然流产；2例孕早期患者病情平稳行负压吸引术；2例孕中期患者,1例行依沙吖啶羊膜腔穿刺引产,1例行剖宫取胎术；仅1例孕早期保留微导管患者溶栓期间出现全身出血倾向,经积极治疗,维持至孕中期行依沙吖啶羊膜腔穿刺引产.3例孕早期神清患者经甘露醇脱水降颅压及低分子肝素积极抗凝治疗,1周后病情平稳行负压吸引术.1例孕早期昏迷患者因弥漫性脑出血、脑疝,经开颅减压治疗无效后死亡.9例患者终止妊娠后均无并发症发生,2例遗留功能缺损,1例合并视物模糊,余6例预后较好.结论:妊娠合并颅内静脉窦血栓形成应积极治疗原发病,先行抗凝、溶栓等治疗,待病情平稳后终止妊娠,妊娠终止方法依据产科特点选择.%Objective:To explore the clinical management of first and second trimester pregnancy complicated with cerebral venous sinus thrombosis (CVST), Methods:Retrospective analysis of 10 pregnancy(8 in first and 2 in second trimester)complicated with CVST from 2000 to 2011. Results:6 patients(4 in first and 2 in second trimester) who were unconsciousness and ensured the diagnosis of cerebral venous sinus thrombosis by DSA were treated with focal thrombolysis by medication and mechanical thrombectomy via femoral or jugular vein approach. Among them, two patients in first trimester also had angioplasty of venous sinus. 2 patients (1 in first and 1 in second trimester) preserved the micro catheter in vivo postoperation. 5 of 6 patients came to consciousness 2 to 7 days after operation ,the clinical symptoms improved markedly. 1 patient (in first trimester) had spontaneous abortion after operation. 2 patients (in first trimester) received a-bortion when in stable condition, one patient in second trimester received ethacridine induction, the other accepted the caesarean section for increased intracranial pressure. Only one patient in first trimester who preserved the micro catheter in vivo suffered from systemic bleeding tendency after operation. She maintained till the second trimester and had ethacridine induction. 3 conscious patients (in first trimester) received dehydration and anticoagulation treatment, then had abortion 1 week after the situation became stable .1 patient (in first trimester) who fell in coma because of diffused intracranial hemorrhage and cerebral herniation was dead after the craniotomy decompression, 9 patients had no complications after termination of pregnancy, 2 patients had mild neurological function defect, 1 patient suffered blurred vision, the other 6 patients had a good prognosis. Conclusions:Pregnancy complicated with CVST should be actively treated, anticoagulation and thrombolysis in advance, then termination of pregnancy when in stable condition is prefered. The choice of pregnancy termination method can be based on the characteristics of obstetrics.