Kalita Jayantee, Pandey Prakash C, Gutti Nagendra B, Das Kuntal K, Kumar Sunil, Singh Varun K
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India.
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India.
J Clin Med. 2025 Apr 24;14(9):2930. doi: 10.3390/jcm14092930.
Patients with cerebral venous thrombosis (CVT) requiring mechanical ventilation (MV) may have a severe procoagulant state, extensive venous sinus thrombosis, and a worse outcome, but there is a paucity of studies on this topic. We compare the clinical risk factors, radiological findings, and outcomes between CVT patients requiring MV and the non-MV group. Consecutive CVT patients admitted to our service were included. Their clinical details, prothrombotic states and MRI and MRV findings were noted. The patients were admitted to the intensive care unit (ICU) if the Glasgow Coma Scale (GCS) score was below 14 and intubated if arterial blood gas analysis was abnormal. All the patients received heparin followed by an oral anticoagulant. In-hospital death was noted, and functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS). Ninety-eight patients with CVT were admitted during the study period; 45 (45.9%) required ICU care, and 18 of them required MV for a median of 6.5 (1-15) days. The MV patients had a shorter duration of illness, a lower GCS score, and protein C deficiency. Twelve (12.2%) patients died: five (27.8%) in the MV, four (14.8%) in the non-MV ICU, and three (5.7%) in the non-MV non-ICU groups. Poor outcomes were 5.5%, 14.8%, and 5.7%, respectively. On Cox regression analysis, the MV had an association with death [adjusted hazard ratio (AHR) 0.40, 95% confidence interval 0.21-0.77; = 0.007] and poor outcome at 3 months (AHR 0.45, 95% CI 0.27-0.76; = 0.003). About 18.4% of CVT patients require MV with a mortality of 27.8%. Amongst the survivors, 90.7% of patients have a good outcome at 3 months.
需要机械通气（MV）的脑静脉血栓形成（CVT）患者可能处于严重的促凝状态，存在广泛的静脉窦血栓形成，且预后较差，但关于这一主题的研究较少。我们比较了需要MV的CVT患者与非MV组之间的临床危险因素、影像学表现和预后。纳入了连续入住我们科室的CVT患者。记录了他们的临床细节、血栓前状态以及MRI和MRV表现。如果格拉斯哥昏迷量表（GCS）评分低于14分，患者被收入重症监护病房（ICU）；如果动脉血气分析异常，则进行插管。所有患者均接受肝素治疗，随后口服抗凝剂。记录住院期间的死亡情况，并使用改良Rankin量表（mRS）评估3个月时的功能预后。在研究期间，98例CVT患者入院；45例（45.9%）需要ICU护理，其中18例需要MV，中位时间为6.5（1 - 15）天。需要MV的患者病程较短、GCS评分较低且存在蛋白C缺乏。12例（12.2%）患者死亡：MV组5例（27.8%），非MV的ICU组4例（14.8%），非MV的非ICU组3例（5.7%）。预后不良的比例分别为5.5%、14.8%和5.7%。经Cox回归分析，MV与死亡相关[调整后风险比（AHR）0.40，95%置信区间0.21 - 0.77；P = 0.007]以及3个月时预后不良相关（AHR 0.45，95% CI 0.27 - 0.76；P = 0.003）。约18.4%的CVT患者需要MV，死亡率为27.8%。在幸存者中，90.7%的患者在3个月时预后良好。
