华法林相关脑出血3例报告及文献复习.pdfVIP

中国临床神经科学 2015 年第 23 卷第 4 期 ·384· Chin J Clin Neurosci 2015, 23 (4), 384~390 论 著 3 梁迎芝，石际俊，徐加平，端光鑫，张 钰，姜春黎，曹勇军 (苏州大学附属第二医院神经内科 215004) 关键词 脑出血；脑栓塞；房颤；抗凝；华法林 摘要 目的 通过分析3 例口服华法林后发生急性脑出血患者的临床资料，总结应用华法林导致脑出血的经验和教训， 为临床诊治提供参考依据。方法 回顾性分析3 例华法林相关脑出血患者的临床特征、影像学特点、治疗方法和预后， 并结合相关文献复习讨论。结果 3 例华法林相关脑出血患者中，2 例因颅内血肿继续扩大而死亡；1 例颅内血肿完全 吸收后，继发脑栓塞，头颅CT 平扫示右侧枕叶新发梗死灶，住院期间予以重启口服华法林抗凝治疗，调整INR 至 2~3 ，病情好转。 严格掌握华法林治疗的适应证，定期监测INR ； 对于脑栓塞风险较大的华法林相关脑出 结论 ① ② 血患者，评估脑出血风险后尽早重新启动抗凝治疗； 早期纠正INR ，可减少血肿扩大。 ③ Warfarin-associated Intracerebral Hemorrhage: Three Cases Reports and Literature Review LIANG Ying-zhi, SHI Ji-jun, XU Jia-ping, DUAN Guang-xin, ZHANG Yu, JIANG Chun-li, CAO Yong-jun Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China. KEY WORDS　intracerebral hemorrhage; cerebral embolism; atrial fibrillation; anticoagulation; warfarin ABSTRACT Aim To summarize the experience and lessons from the cases and provide valuable references for clinical practice by analyzing the clinical data of three patients who developed acute intracerebral hemorrhage during oral anticoagulation with warfarin. Methods Three patients with warfarin- associated intracerebral hemorrhage were enrolled in our study. Their clinical presentation, imaging features, therapies and outcomes were retrospectively analyzed and discussed with reference to the relevant literature and the date. Results Two of the three patients died because of the intracerebral hematoma expansion. One patient suffered cerebral embolism in the right occipital lobe after intracranial hematom