【摘要】 目的总结抗凝、抗血小板药物引发的脑出血的治疗体会。方法回顾性分析因使用抗凝、抗血小板药物引起的28例脑出血患者的临床资料。其中华法令相关脑出血8例,阿司匹林或氯吡格雷相关脑出血20例。结果华法令引起的脑出血,入院CT显示初始出血量较多,接近手术指征,5例术前发生血肿再次扩大。2例因凝血功能无法纠正,最终死亡;3例重度残疾;3例轻度残疾。残疾病例术后1周后开始给予低分子肝素抗凝,2周后完全过渡至口服华法令,未出现再出血或血栓性事件。抗血小板药物引起的脑出血中,11例通过保守治疗好转,9例出现血肿扩大行手术减压。9例手术患者中,1例散在出血病例死于术中脑膨出,1例死于肺部感染;7例出院行康复治疗,其中4例重度残疾,3例轻度残疾。结论在抗凝、抗血小板药物相关的脑出血患者,血肿极容易扩大,需要时刻警惕病情突然变化,尽早进行纠正凝血功能的治疗,以便为后续治疗提供机会。更多还原

【Abstract】 Objective To summarize the treatment experience of 28 cases with intracerebral hemorrhage associated with anticoagulation or antiplatelet drugs.Methods The clinical data of 28 patients with intracerebral hemorrhage were retrospectively analyzed,of whom intracerebral hemorrhage was related to warfarin in 8 cases and to aspirin and clopidogrel in 20 cases.Results The initial volume of intracerebral hemorrhage in 8 cases treated with warfarin was larger on admission and needed surgical evacuation,of whom the hematoma in 5 cases expanded before surgery.Two cases died because of an unsuccessful reversion of poor coagulation situation.Of 6 survival patients,3 cases were with severe disability and 3 cases were with mild disability,for whom the anticoagulant treatment was restarted using low molecular heparin one week after operation and then oral warfarin two weeks after operation without recurrence of rebleeding or thrombotic events thereafter.Of 20 cases with intracerebral hemorrhage associated with antiplatelet drugs,conversation treatment was carried out in 11 cases who were improved and discharged,and surgical decompression was performed because of enlarged hematoma in 9 cases,one case died of cenencephalocele during operation,one case died of pulmonary infection after surgery,and 7 cases discharged for rehabilitation treatment with severe disability in 4 cases and mild disability in 3 cases.Conclusion In the patients with intracerebral hemorrhage associated with oral anticoagulation and antiplatelet drugs,the hematoma is extremely easy to expand and requires constant vigilance for sudden changes in the illness condition.The treatment of correcting coagulation function needs to be done as early as possible in order to provide an opportunities for the follow-up treatment.更多还原