急性脑出血患者的缺血危险因素分析

目的：分析急性脑出血患者的脑缺血相关危险因素，探讨急性脑出血的合理治疗方案。方法：动态观察了54例急性脑出血和75例急性脑梗死患者治疗前后的血液流变学，血浆渗透压，血小板聚集率以及头颅CT的改变。结果：脑出血组和脑死组患者的全血粘度，血浆渗透压，红细胞压积，纤维蛋白原，血小板浓度无明显差异，脑梗死组血小板聚集率明显高于脑出血组（P＜0．05）。31例脑出血患者治疗两周后复查头颅CT，其中有4例患者出现新的脑梗死 灶，此4例患者平均年龄以及纤维蛋白原水平高于脑出血组（P＜0．01），结论：脑出血和脑死是发生于脑血管病变基础上的两个相关联的病变，二者有许多共同的危险因素，脑出血发生及演变过程中可继发病脑梗死，而该过程中血小板聚集率及纤维蛋白原的增高可能与脑出血继发脑梗死的发生有一定的关系，脑出血治疗过程 应强调沦的脑功能监测，尽量有脑出血急性期后早期改善脑循环并同时给予脑保护治疗。

An analysis of ischemic risk factors in patients with cerebral hemorrhage (Attaching an observation of 129 clinical cases)

Objective To investigate the risk factors related with cerebral ischemia in patients with acute cerebral hemorrhage (CH) and to explore an appropriate therapeutic plan for acute CH. Methods Hemorheology, plasma osmotic pressure, platelet aggregation rate and cranial CT were examined in 54 patients with acute CH compared with 75 cases of acute cerebral infarction (CI). Results There was no significant difference of blood viscosity, plasma osmotic pressure, hemotocrit, fibrinogen and platelet concentration between the the two groups, while platelet aggregation rate in CH group was significantly lower than that in CI group ( P < 0.01 ), and it also significantly increased afte two week treatment in CH group ( P < 0.05 ). Among 31 cases with CH re examined by CT after two week treatment, fresh infarctions were found in 4 cases whose ages and fibrinogen levels were significantly higher than those of the CH group ( P < 0.01 ). Conclusion The results suggest that CH and CI are two correlated diseases based on the pathological changes of cerebral vessels and they share many risk factors. Since CH may be followed by CI at the acute stage, Standard monitoring of brain function should be emphasized, and improvement in cerebral circulation as well as treatment with neuroprotective agents should be taken into account early after the acute stage of CH as far as possible.