急性缺血性脑卒中rt-PA静脉溶栓后出血性转化的特殊类型

目的溶栓后出血性转化(hemorrhagic transformation,HT)是重组组织型纤维蛋白溶酶原激活剂(rt-PA)治疗急性缺血性脑卒中的一个重要安全指标。HT有不同的亚型,而不同亚型的预后也不尽相同。我们对急性缺血性脑卒中患者rt-PA静脉溶栓后出现的特殊型HT进行分析。方法对发病3zh内的98例缺血性卒中患者用rt-PA(剂量0．6 mg/kg,最大剂量5 0 mg)进行静脉溶栓治疗,溶栓前后行头颅CT、MRI或数字减影血管造影(DSA)检查判断是否有HT,并判定这种HT与责任病灶的关系。结果溶栓后经CT或MRI检查发现4种特殊的远端HT类型,1例发生蛛网膜下腔出血(SAH),1例梗死部位的对侧出现明显占位效应的脑实质出血,1例出现梗死灶对侧的侧脑室出血,1例出现梗死部位对侧的腔隙性出血。这4例患者所引起的4类HT在临床上均为无症状,预后好。结论对急性缺血性脑卒中的溶栓治疗要坚持动态观和平衡观,对症状性出血性转化的诊断要慎重,充分考虑HT的分型和程度,从而正确判断HT对预后的影响。

Special Types of Hemorrhagic Transformation in Patients Treated by Intravenous Recombinant Tissue Plasminogen Activator

Objective Prediction of hemorrhagic transformation (HT) in patients treated by intravenous recombinant tissue plasminogen activator (rt-PA) is a challenging issue in acute stroke management.HT is categorized according to radiological criteria:hemorrhagic infarction type 1 and type 2 and parenchymal hematoma type 1 and type 2.In this study we will investigate special types of HT after intravenous rt-PA in acute stroke patients.Methods We analyzed the types of HT in 98 patients with ultra-acute ischemic stroke who treated with IV rt-PA.Subjects had IV rt-PA started (0.6 mg/kg,50 mg maximum over 60 minutes) with 3 hours of onset.All patients were examined with CT,MRI scans or DSA before and after thrombolysis.Results We found four special types of HT in patients treated by intravenous rt-PA.They were subarachnoid hemorrhage (SAH),a big remote HT in the opposite of the infarction,lateral ventricle hemorrhage and lacune hemorrhage.The four types of HT were not associated with worse early or late outcome.Conclusion The term symptomatic hemorrhage should be applied with caution because it implies a causal relationship between signs of HT found on CT and clinical deterioration.