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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 5 4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 脑出血组和脑梗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 .0 1) ,而脑出血组入院治疗两周后复查血小板聚集率的平均水平明显高于治疗前平均水平 (P <0 .0 5 )。 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 .0 1)。结论 脑出血和脑梗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。脑出血治疗过程中应强调规范化的脑功能监测 ,尽量在脑出血急性期后早期改善脑循环并同时给予脑保护治疗。
Objective To analyze the risk factors related to cerebral ischemia in patients with acute intracerebral hemorrhage and to explore the reasonable treatment plan for acute intracerebral hemorrhage. Methods The changes of hemorheology, plasma osmolality, platelet aggregation rate and head CT before and after treatment of 54 patients with acute cerebral hemorrhage and 75 patients with acute cerebral infarction were observed dynamically. Results There was no significant difference in whole blood viscosity, plasma osmolality, hematocrit, fibrinogen and platelet concentration between cerebral hemorrhage group and cerebral infarction group. The platelet aggregation rate in cerebral infarction group was significantly higher than that in cerebral hemorrhage group (P <0. 0 1). The average level of platelet aggregation after two weeks of hospital admission in ICH group was significantly higher than that before treatment (P <0.05). 31 patients with cerebral hemorrhage were reviewed two weeks after head CT, of which 4 patients had new cerebral infarction, the average age of these 4 patients and fibrinogen levels were higher than those of intracerebral hemorrhage (P <0.01). Conclusions Cerebral hemorrhage and cerebral infarction are two related diseases that occur on the basis of cerebrovascular disease. There are many common risk factors for both. Cerebral hemorrhage may occur during the evolution and evolution of cerebral infarction, and in the process of platelet aggregation and fibrinogen may be related to cerebral hemorrhage secondary to cerebral infarction have a certain relationship. Should be emphasized in the treatment of cerebral hemorrhage, standardized monitoring of brain function, try to early in the acute phase of cerebral hemorrhage to improve cerebral circulation and concomitant brain protection treatment.