肾病综合征合并颅内静脉窦血栓致失明1例报告

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (2): 160-163.

肾病综合征合并颅内静脉窦血栓致失明1例报告

孙涛，夏正坤，樊忠民，史卓，高远赋

南京军区南京总医院儿科（江苏南京　210002）

收稿日期:2013-07-28 出版日期:2014-02-15 发布日期:2014-02-15

A case of blindness caused by nephritic syndrome with cerebral venous sinus thrombosis

SUN Tao, XIA Zhengkun, FAN Zhongmin, SHI Zhuo, GAO Yuanfu

(Department of Pediatrics, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, Jiangsu, China)

Received:2013-07-28 Online:2014-02-15 Published:2014-02-15

摘要/Abstract

摘要：

　目的　探讨肾病综合征（NS）合并颅内静脉窦血栓（CVST）致失明患儿的临床表现、治疗方案及其预后。方法　分析1例NS合并CVST患儿的临床特点及诊治经过，并复习和总结国内外有关儿童CVST治疗相关研究的最新进展。结果　患儿在NS标准化抗凝治疗过程中突然出现抽搐等癫发作症状，并有复视、双眼视力下降、失明，头颅磁共振及脑血管造影检查（MRV）示CVST形成，肝素化抗凝治疗效果不佳，后予尿激酶溶栓治疗1个月，复查MRV示颅内血栓已完全溶解。目前国际上针对CVST患儿已采取标准化抗凝治疗方案，并随时监测凝血功能如活化部分凝血活酶时间（APTT）、国际标准化比值（INR）等预防出血风险。结论　临床考虑CVST的患儿需早期及时完善神经影像学检查，在排除出血风险后应立即予以抗凝或溶栓治疗，并按疗程使用3~6个月。

Abstract: 　Objectives　To explore the clinical manifestations, treatment and prognosis of a case of blindness caused by nephrotic syndrome with cerebral venous sinus thrombosis (CVST). Methods　The clinical manifestations, diagnosis and treatment of a case of NS with CVST were analyzed. The latest domestic and foreign reseach progresses in treatment for CVST in children were reviewed. Results　Epilepsy suddenly appeared with diplopia, binocular vision loss and blindness in anticoagulant therapy for the child with NS. Brain magnetic resonance venography (MRV) suggested CVST. MRV reexamined showed that the intracranial thrombosis was completely dissolved after urokinase thrombolysis for one month followed by ineffective heparin anticoagulation. At present, international standards of anticoagulant therapy have been adopted in the treatment for CVST patients. Coagulation function (e.g.APTT) and international standardization ratio were monitored in order to prevent bleeding. Conclusions　It is better to perform neural imaging examination early in suspected CVST patients. Anticoagulation and thrombolytic therapy should be given immediately once the risk of bleeding was excluded and used for 3-6 months.

孙涛，夏正坤，樊忠民，史卓，高远赋. 肾病综合征合并颅内静脉窦血栓致失明1例报告[J]. 临床儿科杂志, 2014, 32(2): 160-163.

SUN Tao,XIA Zhengkun,FAN Zhongmin,SHI Zhuo,GAO Yuanfu. A case of blindness caused by nephritic syndrome with cerebral venous sinus thrombosis[J]. , 2014, 32(2): 160-163.

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