冠状动脉造影并发颅内出血的临床特点

Clinical features of coronary angiography complicated intracranial hemorrhage

目的研究冠状动脉造影并发颅内出血的临床特点。方法对12例冠状动脉造影检查并发颅内出血患者的临床资料进行回顾性分析。结果本组患者有高血压病史10例(84%);颅内出血均为急性起病,在冠状动脉造影检查中发病5例,检查后<24 h发病7例。临床表现均有血压显著升高,其中头痛、呕吐8例,意识障碍7例,偏瘫、言语障碍2例,头痛、发热1例,言语障碍、偏身共济失调1例。头颅CT示大脑半球出血9例,其中出血破入脑室和蛛网膜下腔3例,小脑出血并破入脑室1例,蛛网膜下腔出血(SAH)1例;腰穿检查示SAH 1例。经治疗基本痊愈2例,明显好转7例,死亡3例。结论冠状动脉造影并发颅内出血的患者大多有高血压病史,均在造影检查中或检查后24 h内急性发病,发病时血压显著升高,病情较重,病死率较高。

Objective To investigate the clinical features of coronary angiography complicated intracranial hemorrhage. Methods The clinical data of 12 patients with coronary angiography complicated intracranial hemorrhage were retrospectively analyzed. Results There were 10 cases （ 84% ） had hypertension history in this group. The onset of intracrarial hemorrhage in all patients were acute, and the oneset in 5 cases was during coronary angiography, in 7 cases was 〈 24 h after coronary angiography. The clinical manifestations were striking blood pressure elevated in all of the patients, and headache and vomiting in 8 cases, disturbance of consciousness in 7 cases, hemiplegia and speech disorder in 2 cases, headache and fever in 1 case, speech disorder and hemiataxia in 1 case. Skull CT showed that there were hemispheric cerebral hemorrhage in 9 cases, including hemorrhage rupturing into the cerebral ventricles and subarachnoid space in 3 cases, cerebellar hemorrhage and ruptured into the cerebral ventricles in 1 case, subarachnoid hemorrhage （SAH） 1 cases. The lumbar puncture examination showed SAH in 1 case. Two cases were basically caused after treatment, markedlly imporoved in 7 cases, and 3 cases were died. Conclusions Most of the patients with coronary angiography complicated intracranial hemorrhage have hypertension history. The onset in all of them is acute during coronary angiography or within 24 h after coronary angiography. The blood pressure is markedly elevated during onset. This is a serious disease with higher molality.