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目的探讨心源性脑栓塞后出血性转换的特点和防治对策。方法回顾性分析36例心源性脑栓塞后出血转换患者的临床资料及影像学特点。结果风湿性心脏病是心源性脑栓塞最常见的病因(53%),尤其合并房颤的患者高达81%。多数患者发生在颈内动脉系统(67%),特别是大面积梗死患者(50%)。约83%的患者CT表现为点状或片状的出血性梗死或不伴有占位征像的片状血肿,17%的患者表现为脑实质性血肿并伴有占位征像。病前应用过抗凝、降纤、抗血小板等药物治疗者占45%,总病死率为17%。结论风湿性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的转换。
Objective To investigate the characteristics of hemorrhagic transformation after cardioembolic embolism and its prevention and treatment. Methods The clinical data and imaging features of 36 patients with hemorrhage after PTCA were retrospectively analyzed. Results Rheumatic heart disease is the most common cause of cardioembolism (53%), especially in patients with atrial fibrillation up to 81%. Most patients develop in the internal carotid artery system (67%), especially in large infarcts (50%). About 83% of patients showed punctate or patchy hemorrhagic infarction or hematoma with no signs of occupying lesions, and 17% showed hematoma of the brain accompanied by occupying signs. Preoperative application of anticoagulant, fibrinlation, antiplatelet and other drug treatment accounted for 45% of the total case fatality rate was 17%. Conclusions Rheumatic heart disease combined with atrial fibrillation is the most important risk factor of cardioembolism. Large embolization of the internal carotid artery system is more prone to hemorrhagic transformation after embolization.