风湿性心脏病二尖瓣换瓣术后房颤心源性脑栓塞继发二次出血性转化一例  

A case report of twice hemorrhagic transformation after cardioembolic stroke secondary to valvular atrial fibrillation with the history of rheumatic heart diseare and post-valve-replacement for mitral stenosis

作　　者：刘娟娟[1] 贺丹[1] 闫振[1] 张祥建[1] 张玉笛[1] 张英[1] 张瑞敬 LIU Juan-juan;HE Dan;YAN Zhen;ZHANG Xiang-jian;ZHANG Yu-di;ZHANG Ying;ZHANG Rui-jing(Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China)

机构地区：[1]河北医科大学第二医院神经内科,河北省神经病学重点实验室,石家庄050000

出　　处：《脑与神经疾病杂志》2017年第1期21-24,共4页Journal of Brain and Nervous Diseases

摘　　要：目的探讨风湿性心脏病(RHD)二尖瓣换瓣术后房颤心源性脑栓塞出血性转化(HT)的发生、治疗及预后。方法分析本院收治1例RHD二尖瓣换瓣术后房颤心源性脑栓塞继发2次HT患者的临床表现、影像学特点及治疗经过。结果 RHD二尖瓣换瓣术后房颤长期抗凝但不达标时易出现心源性脑栓塞并发HT,积极给予新鲜冰冻血浆补充凝血因子、预防剂量低分子肝素抗凝治疗后抢救成功。结论 1 RHD二尖瓣换瓣术后房颤患者应重视抗凝药的监测和合理应用;2发生脑栓塞后HT时,应及时补充凝血因子;3严格进行血栓栓塞危险评估/抗凝出血危险评估,适时重启抗凝治疗。Objective To explore the occurrence, treatment and prognosis of hemorrhagic cardioembolic stroke secondary to valvular atrial fibrillation. Method The clinical characteristics, imaging result and treatment methods of a patient with twice hemorrhagic transformation after cardioembolism secondary in our hospital was reported.Results Cardioembolic stroke and hemorrhagic transformation were more likely to occured in the patient with valvular atrial fibrillation who receivd long-time anticoagulation outside the required range.After receiving the treatment of fresh frozen plasma to supply blood coagulation factor and prophylactic doses of low molecular weight heparins to coagulate,the patient was rescured successfully. Conclusion Firstly, pay more attention to monitor the coagulation function and the rational use of anticoagulation drugs in the patient with valvular atrial fibrillation. Secondly, receive clotting factor timely for the patient with hemorrhagic transformation after cardioembolic stroke.Thirdly, assess the risk of embolism and bleeding strictly, and restart antigulation in good time and make prognosis better.

关 键 词：风湿性心脏病二尖瓣换瓣术后房颤 心源性脑栓塞 出血性转化 低分子肝素 华法令 

分 类 号：R743.32[医药卫生—神经病学与精神病学]