出血性脑梗死临床特征及诊治研究.docVIP

出血性脑梗死临床特征及诊治研究[摘要] 目的 探讨出血性脑梗死患者的临床特点及其临床诊治。方法 回顾分析31例出血性脑梗死病人的临床诊治资料。结果 本组31例HI患者经头颅CT或MRI证实,经治疗后基本痊愈6例,显著进步13例,进步10例,2例因肺部感染、心衰、肾衰等并发症或多器官功能衰竭死亡。结论 脑梗死发生出血转化后,严重影响病人的预后,及时诊断和治疗出血性脑梗死至关重要。 [关键词] 出血性脑梗死;CT;MRI [中图分类号] R743.3 [中图分类号] A[文章编号] 1673-9701(2009)24-30-03 Clinical Features of Hemorrhagic Cerebral Infarction and Its Diagnosis and Treatment LU Yongmei Internal Medicine,the Hospital of University of Technology of Henan Province,Jiaozuo,Henan 454150,China [Abstract] Objective To investigate clinical features of hemorrhagic cerebral infarction(HCI) and its diagnosis and treatment. Methods Retrospective analysis was made of the data of clinical diagnosis and treatment of 31 cases of HCI. Results Thirty-one cases of HCI were confirmed by using head CT or MRI and after treatment,6 cases were recovered,13 cases were significantly improved,10 cases were improved and 2 cases died from such complications as a lung infection,heart failure,renal failure,etc. or multiple organ functional failure. Conclusion Hemorrhagic transformation of cerebral infarction may seriously impact on prognosis,and therefore,prompt diagnosis and treatment of HCI is essential. [Key Words] Hemorrhagic cerebral infarction;CT;MRI 出血性脑梗死(hemorrhagic infarction,HI)是指脑梗死后梗死区血液再灌注而发生的继发性出血[1],是影响患者生存和致残的严重并发症。随着CT和MRI的广泛应用,HI的临床诊断率大大提高,加上近年来抗凝剂、溶栓剂在急性缺血性卒中患者中的应用,使脑梗死后再出血的风险增加。现将我院2000年5月～2008年8月收治的31例HI患者的临床资料报道如下。 1资料与方法 1.1临床资料 我院2000年5月~2008年8月收治736例脑梗死患者,其中HI 31例,发病率为4.2%。所有患者符合1995年全国脑血管学术会议诊断标准[2],并经神经影像学检查(头颅CT或MRI证实)。31例HI中,男19例,女12例,年龄50～83岁,平均63.2岁。其中有高血压病史20例,糖尿病8例,风湿性心脏病房颤4例,高血脂症4例,冠心病伴房颤3例。 1.2临床表现 本组31例HI均发生脑梗死,急性起病22例,亚急性起病9例。表现为头痛、偏瘫25例;偏身感觉障碍19例;眩晕、呕吐7例;偏盲8例;共济失调4例;伴不同程度的意识障碍11例。发生出血性脑梗死时原有症状加重或出现新的症状、体征者23例,常规复查CT发现者8例,从脑梗死发病至发生出血性转化时间为:50岁者较多,且男性多于女性;中青年发病者多由风湿性心脏病并房颤所致;老年发病者多由高血压、高血糖、冠心病合并房颤所致;②HI多见于脑梗死发病后1～2周,表现为原有症状加重。HI发病时间距缺血性卒中时间越短,症状越重,预后越差;③有占位效应的大面积脑梗死易发生HI;④以血肿型为主者病情较重且预后不良;⑤抗凝、溶栓治疗的患者发生HI后,出血量大,症状重,死亡率高;⑥溶栓、抗凝治疗是恢复缺血区血流再灌注及防止血栓再扩大的有