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目的分析口服华法林后并发急性脊髓出血患者的临床资料,总结华法林相关自发性脊髓硬膜外出血(SSEH)的机制、诊断及治疗。方法回顾性分析1例华法林相关SSEH患者的发病机制、临床特征、影像学特点、治疗方法及预后,结合复习相关文献进行分析讨论。结果该患者经迅速诊断后积极抢救,调整INR至2.0~3.0,并行手术清除血肿,因脊髓出血位置较高,最终死亡。结论 (1)掌握华法林应用的适应证及出血风险评估,定期检测INR;(2)对SSEH,应尽早手术清除硬膜下血肿以解除压迫;(3)SSEH发病罕见,但病情进展迅速,位于高位脊髓的出血患者病死率高。
Objective To analyze the clinical data of patients with acute spinal cord hemorrhage after oral warfarin and summarize the mechanism, diagnosis and treatment of warfarin-associated spontaneous spinal epidural hemorrhage (SSEH). Methods A retrospective analysis was made on the pathogenesis, clinical features, imaging features, treatment and prognosis of 1 warfarin-associated SSEH, and the related literatures were reviewed and discussed. Results The patient was actively rescued after rapid diagnosis. INR was adjusted to 2.0-3.0. Surgery was performed to clear the hematoma. Due to the high level of spinal cord hemorrhage, he eventually died. Conclusions (1) To master the indications of warfarin and risk assessment of bleeding, and to test INR regularly; (2) to remove the subdural hematoma as soon as possible for SSEH; (3) SSEH is rare, but the disease progresses rapidly , High bleeding in patients with high spinal cord mortality.