心房颤动患者口服抗凝药相关脑出血的研究进展

随着人口老龄化日益严重和口服抗凝剂(OAT)的使用增加,目前OAT相关脑出血的发生率较20世纪90年代相比10年间增加了5倍,其病死率高达67%,自发性脑出血病死率为30%~55%。OAT相关脑出血占脑出血的10%~12%。在世界范围内,OAT相关脑出血的发病率是不应用OAT的7~10倍。文中主要从OAT相关脑出血的流行病学、遗传学、主要危险因素、临床特点、预后、影像学特点及最新的治疗策略等进行文献分析,侧重于传统OAT与新型抗凝剂的对比,并且对抗凝药物相关脑出血尚存在争议的问题进行总结。     

肾功能衰竭合并脑出血患者血液净化治疗的体会

血液净化是治疗急慢性肾功能衰竭的主要手段，抗凝是血液透析(HD)的关键步骤，但肾功能衰竭合并脑出血，尤其存在高分解代谢等情况时，由于抗凝剂使用受限制，增加了血液净化的难度，也影响患者的预后。本文就我院近5年的15例肾功能衰竭合并脑出血患者的血液净化治疗方法和体会报道如下。     

脑出血并应激性溃疡相关因素分析

高血压性脑出血患者常并发应激性溃疡,直接影响患者预后,病死率高.本文将我科1995-10～2005-2收治的高血压性脑出血的并发应激性溃疡174例临床资料进行分析,对其发生的相关因素及其机制进行分析,以预防应激性溃疡的发生,从而降低高血压性脑出血的病死率。     

高血压脑出血的治疗进展

脑出血是危害人类健康的主要疾病之一，占全部脑卒中的20％～30％，而高血压和动脉硬化是脑出血的主要原因。随着人们生活水平的提高，工作节奏的加快，高血压性脑出血发病率亦有明显增加及发病年龄低龄化的趋势，脑出血的病死率和致残率居所有卒中类型的首位，发病后首月的病死率高达35％～52％。但其治疗措施还未规范化，最佳处理方法仍然未定。其中一些至关重要的治疗问题的妥善解决，显然能改善预后。作就高血压脑出血的治疗进展作一综述。[第一段]     

脑出血再发15例临床分析

目的 探讨原发性脑出血再发的临床特点.方法 对2001-10～2006-10我科住院治疗的原发性脑出血患者再出血的诱因、年龄、出血间隔时间及临床特点分析.结果 经分析发现,高血压是最危险的因素,年长者非高血压患者情绪波动为再出血的诱因,再出血患者临床症状重、病死率高.结论 预防再出血的主要措施是控制血压、减少诱因.     

高血压脑出血患者外科手术治疗的预后分析

我国已经进入人口老龄化社会,老年人增多,使得高血压脑出血发生率增加,已经成为导致老年人死亡的三大疾病之一,占全部脑卒中的21%～48%,高血压脑出血病死率达30%～50%。高血压脑出血具有病情重、发病急、出血量大、病死率高、致残率高特点,采取外科手术治疗是救治高血压脑出血的重要措施。     

脑出血血肿扩大86例临床分析

目的 观察脑出血血肿扩大的发生率和发生时间、探讨其相关因素及干预措施.方法 对518例脑出血患者进行回顾性研究,总结分析其中86例早期血肿扩大患者的临床资料特点.结果 脑出血血肿扩大的发生率为16、6%,血肿扩大主要发生于发病后6小时内.血肿扩大的主要部位在基底节区(50%),初始出血量10～20 mL者继续出血的发生率最高(47.7%),血肿扩大与血肿形态不规则及收缩压显著升高有关.血肿扩大与既往高血压史、饮酒史、脑卒中史、肝病史等相关.结论 脑出血血肿扩大是病情加重和死亡的主要原因,应充分认识脑出血后继续出血的临床特点及相关因素,密切观察病情,尽早复查头颅CT,采取积极治疗措施.     

复发性脑出血36例临床分析

复发性脑出血患者病死率及致残率高,预后不良,文献报道其发生率为2.7％～6.4％,高血压与淀粉样脑血管病为其主要危险因素。现对我院1993年1月～2001年10月收治的36例复发性脑出血患     

颅内血肿微创清除术的护理体会

脑出血是人类主要致死的疾病之一,内科保守治疗病死率为30％～70％,有深度昏迷及脑干功能受损时则达100％,开颅手术病死率在8％～67.9％。我院自1998年10月开始采用颅内血肿微创清除术,取得满意疗效。     

脑出血继续出血114例临床分析

目的探讨脑出血后继续出血的临床特点及相关因素.方法对114例脑出血后继续出血患者的临床资料进行回顾性分析.结果继续出血的发生率16.76%,于发病后1～126 h,主要在6h内（49.12%）.继续出血部位主要在基底节区（53.51%）;出血量10～30ml者,继续出血的发生率最高,占67.55%.继续出血与饮酒、收缩压升高、血肿外形不规则、脑卒中病史、肝病史有关.血肿扩大是病情加重的主要原因,临床症状恶化率及死亡率较对照组均显著增高（P〈0.01）.结论应充分认识脑出血后继续出血的临床特点及相关因素,密切观察病情,尽早复查头颅CT,采取积极治疗措施.     

The risk of intracerebral hemorrhage during oral anticoagulant treatment: A population study

In a retrospective study of 166 patients, all admitted to the University Hospital, Leiden, The Netherlands, between January 1, 1970 and December 31, 1979, we estimated the relative risk of intracerebral hemorrhage from oral anticoagulant therapy. The risk was more than ten times higher for patients over 50 years of age than for similarly aged untreated individuals in the general population. Within this age group the risk was influenced by neither age nor sex. Hypertension, present in 80% of the patients, was the most important predisposing condition; the risk of bleeding rose with increasing intensity of anticoagulation. There was no substantial difference in clinical condition at onset, rate of Progression, mortality, or degree of recovery between patients with anticoagulant-associated hemorrhage and those with spontaneous intracranial hemorrhage.     

口服抗凝药相关性脑内出血的治疗探讨

目的探讨口服抗凝药相关性脑出血的临床特点和治疗方法。方法回顾性分析36例口服抗凝药相关性脑出血患者的临床资料,所有患者入院后均常规纠正凝血功能障碍,包括静脉输注维生素K和新鲜冷冻血浆。16例行开颅血肿清除,13例行定向血肿穿刺引流,5例仅行脑室外引流,2例保守治疗。结果出院时按GOS评分评定预后,预后良好4例,中残3例,重残6例,植物生存4例,死亡19例。结论口服抗凝药相关性脑出血病情进展快,再出血率和死亡率高。早期纠正凝血功能障碍及清除血肿,防止再出血是治疗的关键。     

Characteristics of Acute Spontaneous Intracerebral Hemorrhage in Patients Receiving Oral Anticoagulants

Objective

We investigated the precise clinical and radiologic characteristics of intracerebral hemorrhage associated with direct oral anticoagulant use.

Anticoagulant-associated intracerebral hemorrhage

The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of atrial fibrillation. Anticoagulant-associated intracerebral hemorrhage now accounts for nearly 20% of all intracranial hemorrhage (ICH). Among patients using warfarin for atrial fibrillation, the annual risk of ICH in trials is 0.3 to 1.0%. Predictors of potential anticoagulant-associated hemorrhage are increasing age, prior ischemic stroke, hypertension, leukoaraiosis, the early period of warfarin use, higher intensity anticoagulation, and antiplatelet use in addition to anticoagulation. Compared with other intracranial hemorrhage patients, anticoagulated patients have a greater risk of hematoma expansion, subsequent clinical deterioration and death, necessitating vigorous reversal of their coagulopathy. Recommended methods of warfarin reversal are administration of intravenous vitamin K and either prothrombin complex concentrates or fresh frozen plasma. Reversal of unfractionated heparin is accomplished with intravenous protamine sulfate. Surgical treatment of intracranial hemorrhage may be life saving in select cases, but has not reduced morbidity or mortality in large randomized trials.     

Electroconvulsive Therapy in Geriatric Patients Undergoing Anticoagulation Therapy

Antidepressant treatment of the depressed geriatric patient can be complicated by concomitant medical illness. We report the successful administration of electroconvulsive therapy (ECT) in three depressed geriatric patients who received the oral anticoagulant warfarin (Coumadin) for cardiovascular disease. The physiologic changes associated with modified ECT and risk factors for intracerebral hemorrhage in patients receiving anticoagulants are discussed.     

手术治疗对脑出血预后影响的探讨

目的:探讨手术治疗与非手术治疗对脑出血(ICH)预后特别是对病死率的影响。方法:比较主要采取内科治疗的ICH241例(A组)和开展手术治疗(包括微创治疗)后的ICH203例(B组)病例资料。结果:A组病死率为48.1%,明显高于B组的15.3%(P<0.005)。结论:手术疗法的开展降低了脑出血患者的病死率,改善了预后。     

Primary intracerebral hemorrhage: impact of CT on incidence

From 1975-1979, the incidence of primary intracerebral hemorrhage (PIH) increased in Rochester, MN, when compared with a previously decreasing incidence. Judging from patients with PIH who were alert at diagnosis, we estimated that 24% of the hemorrhages in earlier years had been mislabeled as infarction. The 30-day survival rate increased from 8% in 1945-1974 to 44% in 1975-1979. The incidence rate was about 45% higher in patients receiving anticoagulant treatment than in those who did not. The increased incidence rate and improved survivorship were attributed to more frequent identification of small PIH by CT.     

Location and outcome of anticoagulant-associated intracerebral hemorrhage

Background  

The characteristics of patients with anticoagulant-associated intracerebral hemorrhage (AAICH) have not been well characterized in a population-based setting.     

Intracerebral hematomas during anticoagulant treatment

We retrospectively studied 79 patients from three centers who suffered an intracerebral hemorrhage during treatment with anticoagulants and compared them with 84 patients from one center who suffered a spontaneous intracerebral hemorrhage without anticoagulant treatment. Mortality after 30 days was slightly higher in patients with anticoagulant treatment (67%) than in those without (55%), and the proportion of patients who attained moderate or complete recovery was slightly smaller in the treated group (22% and 36%, respectively); neither difference was statistically significant. Volume of the supratentorial hematoma was measured from computed tomograms in 70% of the patients in both groups and was significantly greater in the 55 patients treated with anticoagulants than in the 59 patients not so treated. Volume was not related to the degree of anticoagulation. Based on the total number of patients treated with anticoagulants in the Heerlen region, we conclude that for patients older than 50 years of age the risk of intracerebral hemorrhage during anticoagulant treatment is increased approximately eightfold but is unrelated to the degree of anticoagulation. Our results suggest that intracerebral hemorrhage is more frequent and more extensive in patients treated with anticoagulants but that once it has occurred in such patients intracerebral hemorrhage is not significantly more serious than in untreated patients.     

经颅神经内镜额部入路在基底节出血中的应用

目的 探讨经颅神经内镜额部入路在基底节出血中的应用。方法 回顾性分析本科2018年2月-2019年5月用经颅神经内镜额部入路治疗基底节出血的12例患者的临床资料。结果 所有患者均能顺利完成手术,平均血肿排出率为91.56%,手术后GCS评分逐渐提高,出院前增加GCS评分为5.8分。围手术期病死率为0,术后并发2例肺部感染,予以抗感染治疗后恢复,无再出血病例,无颅内感染病例。结论 经颅神经内镜治疗基底节出血安全有效,额部入路对纤维束干扰较少,相对颞部入路更具有优势。