阿替普酶致颅脑出血一例

One Case of Cerebral Hemorrhage Caused by Alteplase

1例82岁女性患者,诊断为"脑梗死",排除脑出血,既往有高血压病史,入院后积极控制血压,待血压(收缩压/舒张压)降至170/95 mm Hg(1 mm Hg=0.133 kPa)以内后予以注射用阿替普酶溶栓;溶栓结束后约7 h,突发呕吐少许胃内容物,血压最高达198/101 mm Hg,颅脑CT检查提示左侧额、顶叶脑出血,期间未予以抗凝血及抗血小板等药物治疗,立即予以减轻脑水肿、利尿及降压等治疗,病情得到有效控制。根据药品不良反应发生时间相关性及因果相关性,考虑该患者颅脑出血与阿替普酶有关。对于超高龄患者,临床使用阿替普酶时,应权衡利弊,严密监测颅脑出血的风险,一旦发生应立即对症治疗,保障用药安全。

One 82-year-old female patient was diagnosed as "cerebral infarction", cerebral hemorrhage was excluded, and the patient had a history of hypertension. After admission, the patient’s blood pressure was actively controlled. And the patient was given alteplase thrombolysis for injection after the blood pressure(systolic blood pressure/diastolic blood pressure) was reduced to 170/95 mm Hg(1 mm Hg=0.133 kpa). About 7 h after the end of thrombolysis, a small amount of stomach contents were suddenly vomited, and the blood pressure was up to 198/101 mm Hg. The CT scan of the brain showed that there were left frontal and parietal cerebral hemorrhage, no anticoagulant and antiplatelet drugs were treated during the period, the patient was given treatment as reducing cerebral edema, diuresis and blood pressure, and then the condition was effectively controlled. According to the time correlation and causal correlation of adverse drug reactions, it was considered that the cerebral hemorrhage of the patient was related to alteplase. For patients with advanced age, the clinical use of alteplase should be weighed against the advantages and disadvantages, the risk of cerebral hemorrhage should be closely monitored, and symptomatic treatment should be carried out immediately, so as to ensure the safety of medication.