急性脑梗死后出血性转化48例临床特点分析

目的：探讨脑梗死后出血性转化（HT）患者的临床特点。方法回顾性分析该院2010年6月至2013年6月收治的HT患者48例，其中，出血性梗死（HI）45例（93．8％），其中HI‐1型27例，HI‐2型18例；脑实质内血肿（PH）3例（6．3％），其中PH‐1型2例，PH‐2型1例。PH‐2型入院时美国国立卫生研究院卒中量表（NIHSS）评分明显高于其他类型HT。进行CT、MRI检查，界定梗死面积，选择不同治疗方式。结果HT患者梗死后出血时间发生在1周内14例（29．2％），1～2周内28例（58．3％）；脑叶梗死25例（52．1％），出血灶均在皮层和（或）皮层下，深部脑实质梗死11例（22．9％），出血灶在梗死灶内或其边缘，脑叶及深部梗死8例，小脑梗死3例，脑干梗死1例，出血灶均在梗死灶内；继发于大面积脑梗死31例（64．6％），继发于小面积脑梗死14例（29．2％），继发于腔隙性脑梗死3例（6．3％）；HI表现为皮质和（或）皮层下白质、脑深部点状、斑片状、条索状、脑回状出血灶；PH表现为梗死区域血肿形成，血肿主要位于深部基底节区。结论大面积脑梗死、脑叶部位的梗死更容易并发HT。HT多发于脑梗死后1～2周内，应当于这段时间内复查头CT或MRI。

The clinical characteristics analysis of 48 cases with hemorrhagic transformation after acute cerebral infarction

Objective To explore the clinical characteristics for patients with hemorrhagic transformation(HT) after acute cere‐bral infarction .Methods In this study ,retrospective analysis was performed for 48 patients HT ,which were classified as HI(n=45 ,93 .8% ) ,HI‐1(n=27) ,HI‐2(n=18);PH(n=3 ,6 .3% ) ,PH‐1(n=2) ,PH‐2(n=1) .PH‐2 admission NIHSS score was signifi‐cantly higher than other types of HT .CT scans and MRT were carried out ,infarction area were defined so that we could choose dif‐ferent treatments .Results The total cases with hemorrhage time within 1 -2 weeks after infarction was 28(58 .3% ) ,while 14 (29 .2% )occured within 1 week .The relationship between HT location and infarction area:25 cases(52 .1% ) occurred cerebral lobe infarction ,for which hemorrhage lesion was located in cortex and(or) subcortical;11 cases (22 .9% ) occurred deep brain parenchy‐ma infarction ,for which hemorrhagic lesion was located inside or on the edge of infarcts;8 cases were lobes and deep infarction ,3 cases were cerebellar infarction ,1 case was brain stem infarction ,all of the hemorrhagic lesion was inside the infarcts .The relation‐ship between HT and infarct size:31 cases(64 .6% ) occured secondary to large area acute cerebral infarction ,14 cases(29 .2% ) oc‐cured secondary to small area of cerebral infarction ,3 cases(6 .3% ) occured secondary to lacunar infarction .Hemorrhage of the HI patients was in the cortex and the subcortical white matter ,with shapes of deep brain dot ,patchy ,funicular or gyrus .Hematoma was formed in cerebral infarction for PH patients ,which mainly located in basal ganglia .Conclusion The HT occurrence is closely relat‐ed to the infarction area and size .Patients with Large area and cerebral lobe infarction have high opportunity for complication of HT .HT usually occurs within 1-2 weeks after cerebral infarction ,during which brain CT or MRI should be routinely reexamined .