Mehraein S, Schmidtke K, Villringer A, Valdueza J M, Masuhr F
Department of Neurology, Charité, Humboldt University, Berlin, Germany.
Cerebrovasc Dis. 2003;15(1-2):17-21. doi: 10.1159/000067117.
We performed a retrospective analysis of 79 patients with cerebral sinus venous thrombosis, who were treated with a fixed regimen of dose-adjusted intravenous heparin, to determine predictors of a fatal course. The parameters investigated were the state of consciousness and the presence of intracranial haemorrhage (ICH) at the start of heparin treatment, involvement of the internal venous system, mean delay from initial symptom to stupor or coma and from initial symptom to hospital admission, focal neurological deficits, mean intracranial circulation time (ICT) on conventional angiography, and age and sex distribution. Mortality rate was 10% in this series (8/79). There was a strong link between the outcome and the level of vigilance: 53% of the patients with stupor or coma at the start of the heparin therapy died (8/15), whereas all of the 64 patients with no more than mildly impaired vigilance survived (p < 0.00001). Furthermore, mean age and mean ICT were significantly higher in the group of patients who died. There was a statistical trend (p = 0.056) for ICH to be more frequent in cases with fatal outcome, but there was reason to assume that ICH represented an epiphenomenon of a severe course rather than an independent predictor. Other investigated parameters were not linked with a fatal outcome.
我们对79例脑静脉窦血栓形成患者进行了回顾性分析，这些患者接受了剂量调整的静脉注射肝素固定方案治疗，以确定致命病程的预测因素。研究的参数包括肝素治疗开始时的意识状态和颅内出血（ICH）情况、颅内静脉系统受累情况、从初始症状到昏迷或昏睡以及从初始症状到入院的平均延迟时间、局灶性神经功能缺损、传统血管造影上的平均颅内循环时间（ICT）以及年龄和性别分布。该系列的死亡率为10%（8/79）。结局与警觉水平之间存在密切联系：肝素治疗开始时处于昏迷或昏睡状态的患者中有53%死亡（8/15），而64例警觉性仅有轻度受损的患者全部存活（p<0.00001）。此外，死亡患者组的平均年龄和平均ICT显著更高。致命结局的病例中ICH更常见有统计学趋势（p=0.056），但有理由认为ICH是严重病程的一种附带现象，而非独立的预测因素。其他研究参数与致命结局无关。
