心源性脑栓塞后出血性转换临床分析(附50例报告)

Clinical analysis of 50 cases of hemorrhage transformation after cardiogenic cerebral embolism

目的探讨心源性脑栓塞后出血性转换(HT)的特点和防治策略。方法回顾50例心源性脑栓塞后出血性转换患者的临床资料及影像学特点。结果心源性脑栓塞最常见的病因为风湿性瓣膜心脏病(58%),特别是合并房颤的人群高达82%。多数患者发生在颈内动脉系统(70%),特别是大面积的梗死患者(50%)。82%的患者表现为点状和线状的出血性梗死(HI)或不伴有占位征象的片状血肿,18%的患者表现为脑实质性血肿(PH)并伴有占位征象。病前应用过抗凝、降纤、抗血小板等药物治疗者占48%。总死亡率达16%。结论风湿性瓣膜心脏病合并房颤是心源性脑栓塞最重要的危险因素,颈内动脉系统的大面积栓塞更容易发生栓塞后出血性转换。病前应用抗凝、降纤、抗血小板药物、活血化瘀中药等是否与出血性转换有关,尚需要深入研究。

Objective To study the characteristics of hemorrhage transformation(HT) after cardiogenic cerebral embolism and therapeutic strategy. Methods To retrospectively analyse the clinical and imaging data of 50 cases with hemorrhage transformation after cerebral embolism. Results Rheumatic valve heart disease was the most common cause of cerebral embolism(58%), while cases with atrial fibrillation were more easily involved(82%). The majority HTs occured in the carotid artery territory(70%), especially in individuals(50%) with large infarction. 82% cases 05 CT showed dot-like, line-like or patch-like appearance, while 18% cases revealed as parenchyma hematoma with space occupying effect. Thrombolysis, anti-coagulation, defibrinogen or anti-platelet agents prior to the onset of symptoms were administratred in 48% cases. The total mortality was 16%. Conclusions Rheumatic valve heart disease with atrial fibrillation is the most important risk factor for cardiogenic cerebral embolism. HT after cerebral embolism occurs frequently in carotid artery territory with large infarction. The association between anti-coagulation, defibrinogen or anti-platelet agents as well as Chinese herbal medication administrated before the symptom onset and HT needs further observation.