Intracranial Hemorrhage in the Hemophiliacs

血友病患者的顱內出血

陳中明(Chung-Ming Chen) ； 梁德城(Der-Cherng Liang) ； 沈淵瑤(En-Yiao Shen)

《Acta Paediatrica Sinica》 30卷6期 (1989/12) Pp. 389-393

摘要

34位在馬偕醫院追蹤治療的血友病患者中，有5位於民國70年至75年間發生過9次顱內出血，其中2位是A型血友病，3位是B型血友病。9次的顱內出血皆經電腦斷層攝影診斷證實，出血的位置有腦內、蜘蛛綱膜下、硬腦膜下3種，其中8次出血節圍涵蓋2種以上。顱內出血病人的年齡由3嘔吐，其次是局部性的神經異常。5位患者於入院後即刻接受凝血因子的補充治療，在沒有外科手術下漸漸地恢復，結果所有患者皆存活，只有1位有左手輕癱的後遺症。平均治療期間爲10±2天。由本研究的觀察，我們建議血友病患者懷疑有顱內出血時，其評估和處置應包括：(1)有外傷病史或沒有外傷病史但有神經症狀時，應該立即補充凝血因子，(2)使用電腦斷層攝影診斷顱內出血，(3)證實有顱內出血時，應即降低顱內壓，並且補充足夠量及時間的凝血因子。

並列摘要

Five of 34 hemophiliac children suffered from nine episodes of intracranial hemorrhage (ICH) from hemophilia A, and another 3 were B hemophiliacs. Diagnoses were confirmed by computed tomographic scan in all nine episodes. The ages of the patients with ICH ranged from 3 months to 4½ years. The most frequent presenting symptoms were headache and vomiting, followed by focal neurological deficits. Eight of 9 episodes had bleeding in multiple regions. All the patients received immediate replacement therapy nad recovered without surgical intervention. The duration of treatment was 10±2 days. All the patients survived and only one of them had neurological sequela as left hand paresis. From this observation we suggest that the treatment of suspected ICH in hemophiliacs should include prompt replacement therapy for either trauma or neurological symptoms in the absence of trauma history, documentation of ICH by computed tomographic scan, and prolonged replacement therapy and control of increased intracranial pressure in hemophiliacs with documented ICH.

並列關鍵字

hemophilia A ； hemophilia B ； intracranial hemorrhage ； replacement therapy