淀粉样脑血管病患者相关性脑出血与治疗

摘要

目的 分析淀粉样脑血管相关性脑出血的临床特点、诊断及治疗方法.方法 对4例病理确诊的淀粉样脑血管病相关性脑出血患者的临床表现、治疗、转归进行总结.结果 4例患者均表现为大量脑叶出血,均行开颅血肿清除术,术后再出血1例,术后联合重组活化凝血因子Ⅶ治疗2例.6个月内再次出血3例,再出血死亡1例.结论 淀粉样脑血管病相关性脑出血临床表现多样,再出血风险高,确诊仍需病理.高龄患者仍可手术治疗,大量出血虽存在手术风险,但仍是挽救患者生命较好的方法.%Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.