Abstract: Objective To explore the prognosis of hemorrhagic transformation in extensive ischemic stroke. Methods According to the image changes and clinical findings, 120 patients with extensive (infarct focus > 45 cm3) ischemic stroke were divided into four groups, namely, asymptomatic hemorrhagic transformation group (group A, 20), without cerebral hemorrhage after cerebral ischemia-reperfusion group (group B, 40), symptomatic cerebral hemorrhagic transformation group (group C, 20), no cerebral ischemia-reperfusion and hemorrhage group (group D, 40). The neurologic deficiency degree at different period, Barthel Index (BI) and modified Rankin Scale (mRS) score at 3 months, and head CT imaging at acute stage (low-density region) and convalescence (encephalomalacia region) were evaluated. The effect of the time of hemorrhagic transformation on prognosis was analysed. Results After 14 d of addmision, the score of neurologic deficiency decreased significantly (24.25 ± 1.18) in group B, but increased (38.74 ± 1.72) and presented clinical exacerbation in group C. There were significant differences among 4 groups (P < 0.05 or P < 0.01, for all). At follow-up 1 month, 3 months and 6 months, the score of neurologic deficiency gradually decreased and the neurological function significantly improved in group A and group B, and presented significant differences in comparison with other 2 groups (P < 0.01, for all). After 3 months, Barthel Index and mRS score were significantly improved and neurological function recovered quite well in group A (88.70 ± 6.20, 1.52 ± 0.78, respectively) and group B (89.30 ± 6.10, 1.53 ± 0.76, respectively) and were all superior to other 2 groups (P < 0.01, for all). After treatment, low ? density region or encephalomalacia region on CT were all reduced and no space occupying signs were seen in group A and group B (P < 0.01, for all). The total therapeutic efficiency rate of group A and group B was 100% and 97.50%, respectively, which were all higher than that in the other 2 groups (P < 0.01, for all). Conclusion Hemorrhagic transformation in ischemic stroke does not always present clinical exacerbation. In the early stage, asymptomatic hemorrhagic transformation is a presentation of reperfusion in ischemic stroke. After treatment, the long?term neurologic improvement is significant and the prognosis is good in patients with reperfusion, and it is superior to that in patients without reperfusion. In patients with symptomatic hemorrhagic transformation, the clinical symptoms are the additional presentations of ischemic stroke with hemorrhagic transformation, and the prognosis is not satisfactory.

Key words: Brain ischemia, Cerebral hemorrhage, Tomography, X-ray computed, Prognosis

摘要： 目的   探讨较大面积缺血性卒中出血性转化的预后。方法   120 例较大面积（梗死灶体积> 45 cm3）缺血性卒中患者，根据影像学改变及临床表现分组；分别观察发病后不同时期患者神经功能缺损程度、3 个月时Barthel 指数、改良Rankin 量表评分及发病急性期头部CT 低密度灶及恢复期软化灶体积，并分析出血性转化发生时间对患者预后的影响。结果   入院第14 天时，阻塞动脉血管再通后无出血性转化患者神经功能缺损评分明显减少（24.25 ± 1.18），症状性出血性转化患者评分增加（38.74 ±1.72），病情加重，各组之间差异具有统计学意义（均P < 0.05 或P < 0.01）；随访1、3 和6 个月时，无症状性出血性转化和阻塞动脉血管再通后无出血性转化患者神经功能缺损评分逐渐减少，神经功能显著改善，与症状性出血性转化组和阻塞动脉血管未再通无出血性转化组比较，差异有统计学意义（均P < 0.01）。发病后3 个月时，无症状性出血性转化及阻塞动脉血管再通后无出血性转化患者Barthel 指数（88.70 ±6.20，89.30 ± 6.10）及改良Rankin 量表评分（1.52 ± 0.78，1.53 ± 0.76）显著改善，神经功能恢复良好，且优于症状性出血性转化组和阻塞动脉血管未再通无出血性转化组（均P < 0.01）。经治疗后，无症状性出血性转化及阻塞动脉血管再通后无出血性转化患者无论低密度灶或软化灶体积均明显缩小且无占位效应（均P < 0.01），治疗总有效率达97.50%，预后优于症状性出血性转化组和阻塞动脉血管未再通无出血性转化组，差异有统计学意义（均P < 0.01）。结论   缺血性卒中患者发生出血性转化并非都会使病情加重，早期无症状性出血性转化为缺血性卒中血管再通的一种表现，经治疗后阻塞动脉血管再通者远期神经功能改善明显，优于阻塞动脉血管未通者，远期预后良好。症状性出血性转化患者预后较差，其临床症状是缺血性卒中与出血性转化的叠加。

关键词: 脑缺血, 脑出血, 体层摄影术, X 线计算机, 预后