出血性脑梗死16例的临床观察

Hemorrhagic cerebral infarction: clinical observation of 16 cases

目的探讨出血性脑梗死的发病机理、临床表现和诊治方法,提高对该疾病的认识。方法回顾性分析16例出血性脑梗死临床资料,16例均有明确高血压病史,发病4 h内溶栓治疗前均行MRI检查示脑梗死征象。15例溶栓后3 d、1例溶栓后6 d查CT示脑内出血,其中3例血肿量>30 ml。结果 16例均经常规治疗,其中3例在常规治疗的基础上行微创血肿抽吸术,术后30 d生存状态良好。全组无死亡病例,治疗后哥拉斯哥昏迷评分(GCS)9～11分11例,12～15分5例。结论出血性脑梗死多发生在脑梗死后3 d内,血压过高或过低、出血倾向、溶栓药物应用不当是发病的危险因素。明确发病过程并及时的影像学确诊是降低病死率的前提。溶栓治疗中监测凝血功能、出血后积极的止血、降颅内压药物的应用及必要的手术治疗是提高疗效的关键。

Objective To investigate the pathogenesis, clinical manifestations, diagnosis and treatment methods of hemorrhagic cerebral infarction, to improve awareness of the disease. Methods A retrospective analysis of clinical data in 16 cases of hemorrhagic cerebral infarction was performed. These patients had a clear history of hypertension, and their MRI examination within 4h before the onset of thrombolytic therapy revealed signs of cerebral infarction. CT showed signs of intracranial hemorrhage in 15 cases 3 days after thromblysis and in 1 case 6 days after thromblysis. Three of them had hematoma greater than 30 ml. Results No deaths was found in 16 cases. Three cases undergoing minimally invasive hematoma aspiration survived in good condition 30 days after surgery. GCS score showed 9 to 11 scores in 11 cases, 12 to 15 scores in 5 cases. Conclusion Hemorrhagic cerebral infarction mainly occurred in 3 days after cerebral infarction. Too high or too low blood pressure, bleeding tendency, improper applica- tion of thrombolytic agents are the risk factors. Defining disease process and timely imaging diagnosis are premise to reduce mortality. Monitoring coagulation during thrombolytic therapy, positire hemostasis after bleeding, using drugs of reducing intracranial pressure and necessary surgery is the key to improving the efficacy.