动脉瘤破裂致蛛网膜下腔出血患者死亡原因分析

目的 探讨动脉瘤破裂致蛛网膜下腔出血患者住院期间死亡的原因并提出相应的对策. 方法 回顾性分析江苏大学附属人民医院神经外科自2003年1月至2010年12月收治且住院期间死亡的24例颅内动脉瘤破裂致自发性蛛网膜下腔出血患者的临床资料和死亡原因.结果 死亡原因分别为:颅内再出血11例,其中术前再出血5例,介入栓塞术中出血3例,栓塞术后颅内再次出血3例；术后脑血管痉挛或脑梗死8例,其中早期(术后3d内)CT表现为脑梗死3例,晚期(术后3d后)脑血管痉挛或脑梗死5例；椎动脉瘤栓塞术后呼吸骤停1例；肺部感染3例；肾功能衰竭1例. 结论 颅内再次出血、脑梗死或脑血管痉挛、非神经系统并发症是动脉瘤性蛛网膜下腔出血患者住院期间主要的死亡原因.

Causes of death in patients with subarachnoid hemorrhage induced by ruptured cerebral aneurysms

Objective To analyze the risk factors of death in patients with subarachnoid hemorrhage induced by ruptured cerebral aneurysms and provide some therapeutic strategies. Methods A retrospective analysis of the clinical data and causes of death in 24 patients died from subarachnoid hemorrhage induced by ruptured cerebral aneurysms from January 2003 to December 2010 was performed. Results Eleven patients died from intra-cerebral re-bleeding: 5 patients had re-bleeding before the interventional embolization,3 had bleeding during the surgery,and 3 had re-bleeding after the surgery. Eight patients died from vasospasm or cerebral infarction after the surgery, including 3 with cerebral infarction under early-stage CT (within 3 d of surgery) and 5 with vasospasm or cerebral infarction under late-stage CT (3 d after the surgery); 1 died from respiratory arrest after the operation; 3 died from pulmonary infection; and 1 died from renal failure. Conclusion Re-bleeding,vasospasm/cerebral infarction and Non- neurological complications are the major causes of death in patients died from aneurysmal subarachnoid hemorrhage induced by ruptured cerebral aneurysms.Increase the awareness of causes of death will help reduce the mortality.