浏览全部资源
扫码关注微信
21例儿童创伤性颅内静脉窦血栓的临床分析
Clinical analysis of traumatic cerebral venous sinus thrombosis in children
- 第三军医大学学报 2020年42卷第22期 页码：2190-2194
- 作者机构：
重庆 400014，重庆医科大学附属儿童医院神经外科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室
- 作者简介：
[ 周建军，E-mail: 258276230@qq.com ZHOU Jianjun, E-mail: 258276230@qq.com
- 基金信息：国家临床重点专科建设项目(国卫办医函544)
DOI：10.16016/j.1000-5404.202006151
中图分类号： R181.32;R726.511;R743.32收稿：2020-06-17，
修回：2020-09-11，
纸质出版：2020-11-30
- 稿件说明：
移动端阅览
赵雪灵, 程杨, 梁平, 等. 21例儿童创伤性颅内静脉窦血栓的临床分析[J]. 第三军医大学学报, 2020,42(22):2190-2194.
Xueling ZHAO, Yang CHENG, Ping LIANG, et al. Clinical analysis of traumatic cerebral venous sinus thrombosis in children[J]. Journal of Third Military Medical University, 2020, 42(22): 2190-2194.
赵雪灵, 程杨, 梁平, 等. 21例儿童创伤性颅内静脉窦血栓的临床分析[J]. 第三军医大学学报, 2020,42(22):2190-2194. DOI： 10.16016/j.1000-5404.202006151.
Xueling ZHAO, Yang CHENG, Ping LIANG, et al. Clinical analysis of traumatic cerebral venous sinus thrombosis in children[J]. Journal of Third Military Medical University, 2020, 42(22): 2190-2194. DOI： 10.16016/j.1000-5404.202006151.
摘要
目的
2
探讨儿童创伤性颅内静脉窦血栓的形成机制、临床表现、治疗方案及预后。
方法
2
回顾性分析我院2009年1月至2019年12月收治创伤性颅内静脉窦血栓患儿临床资料，总结其临床表现、形成机制、影像学特点，对比肝素与非肝素治疗效果。
结果
2
本组患儿共21例，主要临床症状为头痛、呕吐及活动量减少，颅内压增高，视乳头水肿发生率高(81%)。血栓形成部位多伴有跨窦的颅骨骨折或硬膜外血肿；血栓初次减少的时间为(18.33±6.15) d，肝素组显著短于非肝素组，血栓残余平均比率为11%(3.0%
14.5%)，肝素组血栓残余比率为5%(2%，13%)，显著低于非肝素组。两组间的血栓稳定时间及D-二聚体减少时间差异无统计学意义(
P
>
0.05)。
结论
2
儿童创伤性颅内静脉窦血栓常见于跨静脉窦的颅骨骨折及压迫静脉窦的硬膜外血肿，抗凝治疗可使血栓初次减少时间缩短，血栓残余比缩小，加速血栓再通，再通效果更佳，短期预后较好。
Abstract
Objective
2
To investigate the mechanism of formation of traumatic cerebral venous sinus thrombosis (CVST) in children and analyze the clinical manifestations
treatment and prognosis of CVST.
Methods
2
We performed a retrospective analysis of 21 children with traumatic CVST treated in our hospital between January 2009 and December 2019. The clinical manifestations
causes of thrombosis
imaging characteristics and the effects of heparin versus non-heparin treatments were analyzed.
Results
2
Among the 21 children with CVST
the main clinical symptoms included headache
vomiting
decreased activity
in
creased intracranial pressure (30.53±5.07 cmH
2
O)
and papilledema (81%). Cranial fractures involving different sinuses or epidural hematoma was common in the children with CVST. The time of first-time hematoma volume reduction was 18.33±6.15 d in these children
and was significantly shorter in children receiving low-molecular-weight heparin (LMWH) treatment than in those without LMWH treatment (15.00±5.13
vs
23.75±2.96 d
P
<
0.001). The percentage of residual hematoma was meanly 11% (3.0%
14.5%) in the cohort
and it was significantly lower in children with LMWH treatment than in those without. The hematoma stabilization time was 31.08±8.81 d and 37.75±5.01 d and the D-dimer stabilization time was 12.92±4.62 d and 14.62±2.82 d in LMWH group and non-LMWH group
respectively
showing no significant differences between the 2 groups (
P
>
0.05).
Conclusion
2
CVST in children often occurs following skull fracture across the venous sinuses or epidural hematoma that compresses the venous sinus. Anticoagulation therapy can shorten the time of hematoma volume reduction
reduce the volume of residual hematoma
and accelerate recanalization to improve the short-term outcomes of the patients.
关键词
Keywords
references
MUTHUKUMAR N. Uncommon cause of sinus thrombosis following closed mild head injury in a child[J]. Childs Nerv Syst, 2005, 21(1): 86-88. DOI: 10.1007/s00381-004-0926-2.
SAPOSNIK G, BARINAGARREMENTERIA F, BROWN R D, et al . Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association[J ] . Stroke, 2011, 42(4): 1158-1192. DOI: 10.1161/str.0b013e31820a8364.
AWAD A W, BHARDWAJ R. Acute posttraumatic pediatric cerebral venous thrombosis: Case report and review of literature[J]. Surg Neurol Int, 2014, 5(1): 53. DOI: 10.4103/2152-7806.130908.
刘赵鹤, 靳文, 郭俊秀.小儿外伤后侧窦血栓形成五例并文献复习[J].中华神经外科杂志, 2017(6): 631-633. DOI: 10.3760/cma.j.issn.1001-2346.2017.06.021
LIU Z H, JIN W, GUO J X. Five cases of posterior sinus thrombosis in children with trauma and literature review[J]. Chin J Clin Neurosurg, 2017, 33(06): 631-633. DOI: 10.3760/cma.j.issn.1001-2346.2017.06.021
DELGADO ALMANDOZ J E, KELLY H R, SCHAEFER P W, et al . Prevalence of traumaticdural venous sinus throm-bosis in high-risk acute blunt head trauma patients evaluated with multidetector CT venography[J ] . Radiology, 2010, 255(2): 570-577. DOI: 10.1148/radiol.10091565.
LAKHKAR B, LAKHKAR B, SINGH B R, et al . Traumatic dural sinus thrombosis causing persistent headache in a child[J ] . J Emerg Trauma Shock, 2010, 3(1): 73-75. DOI: 10.4103/0974-2700.58658.
DALGIÇ A, SEÇER M, ERGVNGÖR F, et al . Dural sinus thrombosis following head injury: report of two cases and review of the literature[J ] . Turk Neurosurg, 2008, 18(1): 70-77. DOI: 10.1016/j.surneu.2007.08.038
许丙洋, 王守森.颅脑损伤继发颅内静脉窦血栓形成的诊断和治疗[J].中国临床神经外科杂志, 2015, 20(1): 58-61. DOI: 10.13798/j.issn.1009-153X.2015.01.020
XU B Y, WANG S S. Diagnosis and treatment of intracranial venous sinus thrombosis secondary to head injury[J]. Chin J Clin Neurosurg, 2015, 20(1): 58-61. DOI: 10.13798/j.issn.1009-153X.2015.01.020
FISCHER C, GOLDSTEIN J, EDLOW J. Cerebral venous sinus thrombosis in the emergency department: retrospective analysis of 17 cases and review of the literature[J]. J Emerg Med, 2010, 38(2): 140-147. DOI: 10.1016/j.jemermed.2009.08.061.
AYANZEN R H, BIRD C R, KELLER P J, et al . Cerebral MR venography: normal anatomy and potential diagnostic pitfalls[J ] . AJNR Am J Neuroradiol, 2000, 21(1): 74-78. DOI: 10.1080/028418500127344867
范文辉, 迟路湘.脑静脉窦血栓形成的临床研究[J].第三军医大学学报, 2004, 26(19): 1783-1784. DOI:CNKI: SUN: DSDX.0.2004-19-035
FAN W H, CHI L X. Clinical study of cerebral venous thrombosis[J]. Acta Acad Med Mil Tertiae, 2004, 26(19): 1783-1784. DOI:CNKI: SUN: DSDX.0.2004-19-035
DENTALI F, CROWTHER M, AGENO W.Thrombophilic abnormalities, oral contraceptives, and risk of cerebral vein thrombosis: a meta-analysis[J]. Blood, 2006, 107(7): 2766-2773. DOI: 10.1182/blood-2005-09-3578.
SOUSA J, O'BRIEN D, BARTLETT R, et al . Sigmoid sinus thrombosis in a child after closed head injury[J ] . Br J Neurosurg, 2004, 18(2): 187-188. DOI: 10.1080/02688690410001681082.
BRORS D, SCHÄFERS M, SCHICK B, et al . Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss[J ] . Neuroradiology, 2001, 43(2): 144-146. DOI: 10.1007/pl00006045.
0
浏览量
0
下载量
0
CSCD
- 网络PDF下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
