急性脑梗死出血性转化临床分析

CLINICAL ANALYSIS OF HEMORRHAGIC TRANSFORMATION IN ACUTE CEREBRAL INFARCTION

目的探讨脑梗死出血性转化(hemorhagic transformation,HT)的发病机制及相关危险因素。方法分析36例脑梗死出血性转化患者临床和神经影像学资料。在发病21d内复查头部CT或MRI,分为出血性梗死(hemorrhagic infarction,HI)21例和脑实质血肿(parenchymal hematoma,PH)15例。将这二种分为四型,HI1、HI2、PH1和PH2,根据美国国立卫生研究院脑卒中量表(NIHSS)对患者于病初及出院时各评分1次,以第二次评分减少作为脑功能改善的指标。结果 HI1、HI2型患者入院时及出院时NIHSS评分差异有统计学意义(P<0.01);PH1、PH2型患者入院时及出院时NIHSS评分差异无统计学意义(P>0.05)。结论 HT的发生是多因素、多机制共同作用的结果。大面积脑梗死,应用溶栓、抗凝、降纤及抗聚治疗,高胆固醇血症及心房颤动史是HT的主要危险因素。

Objective To investigate the pathogenesis and related risk factors of hemorrhagic transformation（HT） after cerebral infarction.Methods The clinical and neuroimaging data were analyzed retrospectively in 36 patients with HT.Head CT or MRI was counterchecked within 21 days after the onset.The patients were divided into HT group（21 cases） and parenchymal hematoma group（PH,15 cases） which were defined as HI1,HI2,HP1 and HP2 types.The patients were estimated according to NIHSS at admission and discharging in hospital,and the decrease of second NIHSS scores was regarded as index of brain function improvement.Results Compare with admission,there were significant differences（P0.01） on NIHSS scores for HI1 and HI2 patients and there were no significant differences（P0.05） on NIHSS scores for PH1 and PH2 patients on discharging in hospital.Conclusion The HT is the result of joint effort of multiple factors and multiple mechanism,whose major risk factors are the massive cerebral infarction,institution of anticoagulants,thrombolytic agents,lower fibrinogen and anti-platelet aggregation,hypercholesterolemia and previous atrial fibrillation.