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目的探讨心源性脑栓塞后出血性转换(HT)的特点和防治策略。方法回顾50例心源性脑栓塞后出血性转换患者的临床资料及影像学特点。结果心源性脑栓塞最常见的病因为风湿性瓣膜心脏病(58%),特别是合并房颤的人群高达82%。多数患者发生在颈内动脉系统(70%),特别是大面积的梗死患者(50%)。82%的患者表现为点状和线状的出血性梗死(HI)或不伴有占位征象的片状血肿,18%的患者表现为脑实质性血肿(PH)并伴有占位征象。病前应用过抗凝、降纤、抗血小板等药物治疗者占48%。总死亡率达16%。结论风湿性瓣膜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转换。病前应用抗凝、降纤、抗血小板药物、活血化瘀中药等是否与出血性转换有关,尚需要深入研究。
Objective To investigate the characteristics of hemorrhagic transformation (HT) after cardioembolism and its prevention and treatment. Methods The clinical data and imaging features of 50 patients with hemorrhagic transformation after cardioembolism were retrospectively reviewed. Results The most common cause of cardioembolic stroke was rheumatic valvular heart disease (58%), especially up to 82% of patients with atrial fibrillation. Most patients occur in the internal carotid artery system (70%), especially in large infarcts (50%). 82% of patients showed punctate and linear hemorrhagic infarction (HI) or hematoma with no signs of occupying the site, 18% of patients showed cerebral parenchymal hematomas (PH) with signs of occupancy. Preoperative application of anticoagulants, fibrinolytic, antiplatelet drugs accounted for 48%. Total mortality rate of 16%. Conclusions Rheumatic valvular heart disease with atrial fibrillation is the most important risk factor of cardioembolism. Large embolization of the internal carotid artery system is more prone to hemorrhagic conversion after embolization. Preoperative application of anticoagulant, fibrinolytic, antiplatelet drugs, traditional Chinese medicine and other blood circulation and hemorrhagic conversion, still need further study.