蛛网膜下腔出血后迟发性脑血管痉挛的临床研究

为了探讨蛛网膜下腔出血（ＳＡＨ）后迟发性脑血管痉挛（ＤＣＶＳ）的临床规律，本文对６１例ＳＡＨ住院病人的脑动脉造影（ＣＡＧ）、ＣＴ及临床资料进行了回顾研究，结果如下：１、ＳＡＨ并ＤＣＶＳ的主要病因为颅内动脉瘤破裂，ＤＣＶＳ发生与颅内动脉瘤所在的部位及大小无明显关系．ＤＣＶＳ时轻度痉挛略多于重度痉挛．２、ＣＴ见基底池存在明显的高密度影时，能预示ＤＣＶＳ的发生。３、ＤＣＶＳ常与脑内血肿、脑室出血、脑积水或脑梗塞同时存在。４、ＳＡＨ再发出血，尤其是近期再发出血，可能产生或加重ＤＣＶＳ．５、ＤＣＶＳ的发生及程度与临床病情严重程度有关，ＤＣＶＳ的程度越重，临床病情也越重。６、ＤＣＶＳ的主要体征为意识障碍，近半数的病人有神经示位体征。

A clinical study of delayed cerebral vasospasm following subarachnoid hemorrhage

The aim of this study was to investigate the clinical features of delayed cerebral vasospasm (DCVS) following subarachnoid hemorrhage(SAH). The records of cerebral angiography (CAG), CT scan and the clinical details of 61 inpatients with SAH were retrospectively reviewed. The main results and conclusions were as follows. (1) DCVS was mainly caused by the rupture of aneurysms. There was no correlation between development of DCVS with sizes or regions of the ruptur of aneuopms. The slight narrowing of the vascular walls were more than severe narrowing during DCVS, (2) thick collections of blood in the basilar cistern on early CT scan after SAH were highly predictive of developing DCVS, (3) the neurological complications, such as intracerebral hemorrhage, cerebral ventricular hemorrhage, hydroencephalus and cerebral infarction were significantly common in patients with DCVS,(4) SAH rebleeding, especially recent rebleeding, might increase the development of DCVS, (5) the more severe DCVS was, the poorer clinical state was. Severe and diffuse DCVS was seen in the patients in grade tV and V, (6) the disorder of consciousness following SAH were seen in approximately two-3rd of the patients with DCVS. Nearly half of the patients with DCVS appeared to have the neurological deficits.