动脉瘤性与非动脉瘤性蛛网膜下腔出血的比较

目的探讨动脉瘤性和非动脉瘤性蛛网膜下腔出血（SAH）的诊断、治疗和预后的差异.方法对同期发现的非动脉瘤性SAH 16例与动脉瘤性SAH 117例患者的临床表现、入院时意识状况、Hunt and Hess分级以及头颅CT扫描、并发症及预后进行比较和分析.结果非动脉瘤性SAH与非动脉瘤性SAH相比,前者临床症状轻,无局灶性神经体征,16例中仅有2例出现意识障碍（12.5%,2/16）,93.75%（15/16）患者Hunt and Hess分级为Ⅰ、Ⅱ级,Franz量化为（7.2＋3.2）分.结论非动脉瘤性SAH,尤其是非动脉瘤性中脑周围SAH是一种特殊类型的出血模式,临床过程轻微,并发症少,预后良好.     

外科治疗高分级动脉瘤性蛛网膜下腔出血的随访分析

目的探讨高分级颅内动脉瘤的治疗方式和影响预后的因素。方法回顾性分析南方医科大学第三附属医院神经外科2011年4月至2017年7月收治的24例高级别颅内动脉瘤患者的临床资料和影像资料,采用mRS量表评价患者的预后,通过单因素t检验和卡方检验分析影响预后的因素。结果预后良好12例,预后差12例。单因素分析显示患者年龄≥65岁(P=0.028)、高血压病史(P=0.041)、动脉瘤直径5mm(P=0.041)、急性脑积水(P=0.028)与预后不良有关。Hunt-HessⅣ级患者不同手术时机分组间死亡率差异有统计学意义(P=0.018);Hunt-HessⅤ级患者不同手术时机分组间死亡率差异无统计学意义(P=0.505)。结论通过积极的治疗,高级别动脉瘤性蛛网膜下腔出血患者可以取得较好的预后。患者的年龄、高血压病史、急性脑积水、动脉瘤大小与预后相关。超早期手术有助于降低Hunt-HessⅣ级患者死亡率。     

动脉瘤性蛛网膜下腔出血致脑积水治疗体会

目的 探讨动脉瘤性蛛网膜下腔出血致脑积水的手术时机、方法和临床效果.方法 2008-06-2012-12我院收治动脉瘤性蛛网膜下腔出血患者226例,其中25例并发脑积水,对其治疗方法、手术时机、临床效果进行回顾分析.结果 25例中急性脑积水9例,采用侧脑室额角穿刺外引流;16例行脑室腹腔分流手术,均恢复良好;22例脑室系统基本恢复正常;3例脑室系统较前缩小,但无临床症状;无感染病例.结论 动脉瘤性蛛网膜下腔出血并发脑积水,要针对不同情况给予不同的手术方法才能取得较好的临床效果.     

动脉瘤性蛛网膜下腔出血后脑积水

脑积水是动脉瘤性蛛网膜下腔出血 (ＳＡＨ)后的常见并发症之一 ,对病人的预后有直接的影响 ,本文报告 2 1例动脉瘤性ＳＡＨ后脑积水的治疗。临床资料和治疗方法　　 1.一般资料 :男 9例 ,女 12例 ,年龄 2 2～ 6 6岁 ,平均 4 7 5岁。颈内 后交通动脉瘤 10例 ,前交通动脉瘤 7例 ,大脑中动脉动脉瘤 2例 ,大脑后动脉动脉瘤 2例。ＳＡＨ次数 :1次 2例、 2次 15例、3次 3例、 4次 1例。动脉瘤大小 :0 6～ 1 0ｃｍ 10例、 1 1～ 1 5ｃｍ 7例、 1 6～ 2 5ｃｍ 4例。Ｈｕｎｔ Ｈｅｓｓ分级 :Ⅱ级 3例、Ⅲ级 4例、Ⅳ级 11例、Ⅴ级 3例。临床症状 :…     

脑动脉瘤致蛛网膜下腔出血的脑血管痉挛及早期手术问题

脑动脉瘤破裂引起的蛛网膜下腔出血所致之血管痉挛是外科手术前后最常见和最严重的并发症之一。根据16个国家68个神经外科中心联合研究的资料,在3346例患者中有33.5％血管痉挛是病情恶化和死亡的主要原因。在住院患者中,因血管痉挛导致死亡和病情恶化者占14％。显而易见,血管痉挛引起了包括神经外科在内的临床医师的关注,并提出了包括早期手术在内的防治措施。现将有关问题的研究进展综述如下。     

动脉瘤破裂致蛛网膜下腔出血的早期手术治疗

1对象与方法我院自2004年1月～2005年7月对15例颅内动瘤施行早期动脉瘤夹闭术,其中男8例,女7例;年龄9～60岁,平均34.5岁.均以蛛网膜下腔出血(SAH)为首发症状.术前Hunt分级:Ⅰ级4例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.其中合并癫癎5例,偏瘫4例,动眼神经麻痹3例.DSA检查示动脉瘤位于大脑中动脉瘤M1段5例,颈内动脉-后交通动脉4例,前交通动脉3例,颈内动脉3例.     

硫酸镁治疗动脉瘤性蛛网膜下腔出血的剂量评估

目的 探讨硫酸镁对动脉瘤性蛛网膜下腔出血(SAH)后迟发性脑缺血的预防和治疗作用.方法 采用随机、对照方法,对SAH病人在发病早期静脉应用硫酸镁(24 mmol/d),连续使用至动脉瘤填塞后14 d,治疗前检查镁浓度,以后至少每2天检查1次,并与92例常规治疗的病人相比较,观察血清镁浓度能否达1.0～1.5 mmol/L的目标水平.结果 126例应用硫酸镁治疗的病人,平均镁浓度为(1.37±0.14) mmol/L,在整个治疗期间,有108例病人血清镁维持在目标水平,单次检测有2例病人血清镁浓度<1.0 mmol/L(0.79 mmol/L和0.82 mmol/L),1次或多次检测中,15例病人血镁浓度>2.0 mmol/L.结论 对大多数SAH病人来说,每天给予静脉补充24 mmol/L的硫酸镁,容易使血镁浓度维持在1.0～1.5 mmol/L,且无明显不良反应.     

侧脑室穿刺外引流在高分级动脉瘤性蛛网膜下腔出血手术中的应用

目的 探讨侧脑室穿刺外引流在高分级动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)手术中的应用价值.方法 回顾性分析84例高分级aSAH病人的临床资料,根据脑脊液引流方式不同分为研究组和对照组,研究组39例行侧脑室钻孔引流,对照组45例排除手术禁忌后行腰大池引流,...     

动脉瘤性蛛网膜下腔出血37例临床分析

1 临床资料 1.1一般资料男9例,女28例,年龄30～77岁,平均54.6岁。Hunt-Hess分级:Ⅰ级3例,Ⅱ级17例,Ⅲ级13例,Ⅳ级3例,Ⅴ级1例。合并动眼神经麻痹10例,脑内血肿和脑积水各5例。SAH诊断依据:突发性剧烈头痛、恶心、呕吐病史,CT示蛛网膜下腔出血或腰穿示血性脑脊液。     

复合手术治疗颅内动脉瘤破裂致蛛网膜下腔出血疗效观察

目的对比研究复合手术与栓塞手术治疗颅内动脉瘤破裂致蛛网膜下腔出血疗效。方法回顾性描述性研究2016年1月至2018年12月开封市中医院和河南大学第一附属医院治疗颅内动脉瘤破裂致蛛网膜下腔出血的13例复合手术与16例栓塞手术病例。结果术后栓塞组术后发生2例脑积水、1例脑梗死、1例脑血管痉挛,复合组未发生;两组各有1例发生术后肺部感染;复合组2例发生术后颅内感染,栓塞组未发生;两组各有1例发生术后下肢深静脉血栓形成。两组均无围手术期死亡病例。两组并发症发生有统计学差异(P0.05)。出院时复合组有4例功能障碍,栓塞组有8例功能障碍;两组出院及随访GOS分级有统计学差异(P 0.05)。栓塞组1例1年内动脉瘤再破裂出血,复合组未发生,两组有统计学差异(P0.05)。结论复合手术在颅内动脉瘤致蛛网膜下腔出血治疗上有一定优势。     

Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage

Background While efforts have been made to document short-term outcomes following poor grade aneurysmal subarachnoid hemorrhage (aSAH), no data exist concerning the degree of delayed improvement in neurological function. Here we assess cognitive function, level of independence, and quality of life (QoL) over 12 months following poor grade aSAH. Methods Data on definitively treated poor grade patients (Hunt and Hess grade IV or V) surviving 12 months post-aSAH were obtained through a prospectively maintained SAH database. Demographic information, medical history, and clinical course were analyzed. Health outcomes assessments completed by surviving patients at discharge (DC), three months (3 M) and 12 months (12 M) follow-up, including the Telephone Interview for Cognitive Status (TICS), Barthel Index (BI), and Sickness Impact Profile (SIP), were used to evaluate cognitive function, level of independence, and QoL. Findings Fifty-six poor grade patients underwent aneurysm-securing intervention and survived at least 12 months post-aSAH. Thirty-five (63%) surviving patients underwent health outcomes assessments at DC, 3 M and 12 M post-aSAH. A majority of patients had improved scores on the TICS (DC to 3 M: 91%; 3 M to 12 M: 82%), BI (DC to 3 M: 96%; 3 M to 12 M: 92%), and SIP (3 M to 12 M: 80%) following aSAH. Using paired-sample analyses, significant improvement on each test was observed. Conclusion A substantial portion of patients experience cognitive recovery, increased independence, and improved QoL following poor grade aSAH. Delayed follow-up assessments are necessary when evaluating functional recovery in this population. These findings have the potential to impact poor grade aSAH management and prognosis. Received in revised form: 24 July 2005     

动脉瘤性蛛网膜下腔出血及相关并发症的诊治

目的探讨动脉瘤性蛛网膜下腔出血（SAH）的血管内治疗及相关并发症处理。方法对动脉瘤性SAH患者早期诊断,采用血管内治疗并对其并发症进行处理。结论本组40例动脉瘤行栓塞治疗,其中栓塞达90%者26例,95%栓塞11例,完全栓塞3例。死亡4例,1例保守治疗后出院。结论动脉瘤性SAH的早期诊治及围手术期治疗极其重要,是降低死亡率及致残率的关键,介入治疗受血管痉挛的影响小。     

Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage

OBJECTIVE: To assess predictors for cognitive impairment one year after spontaneous subarachnoid hemorrhage (SAH). Evaluated predictors were the total amount of cisternal blood seen on computed tomography (CT) in the acute phase as measured by the Fisher grade, neurological grade at admission classified according to the Hunt and Hess scale, aneurysm site and patient's age, gender and education level. METHOD: 44 patients were operated by surgical clipping within 72 hours after CT verified aneurysmal SAH. After twelve months the remaining 42 patients were assessed by neuropsychological test, Beck Depression Inventory (BDI), the Glasgow Outcome Scale (GOS) and CT. Multiple regression analysis was conducted where predictor variables were independent factors and a global impairment index calculated for each patient was the dependent factor. RESULTS: The Fisher grade was the only independent predictor for neuropsychological impairment. Most patients had good neurological outcome as measured by the GOS and at the same time suffered from some degree of cognitive impairment at follow-up. Individual analysis of cognitive test scores showed mild to moderate dysfunction across multiple cognitive domains. Most frequent impairments were found in domains of memory, executive function and speed of information processing. Age below 50 years was associated with relatively better outcome. CONCLUSION: The severity of cognitive impairment one year post SAH is predicted by the volume of blood in the subarachnoid space as measured by the Fisher score.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛危险因素的分析

目的 探讨动脉瘤性蛛网膜下腔出血后脑血管痉挛的危险因素.方法 回顾性分析93例动脉瘤性蛛网膜下腔出血患者的临床资料,研究脑血管痉挛的危险因素.结果 93例动脉瘤性蛛网膜下腔出血患者中共有28例患者(30.1％)发生脑血管痉挛.Hunt-Hess分级≥Ⅲ级血管痉挛发生率明显高于Hunt-Hess分级Ⅰ-Ⅱ级,差异有统计学意义(P＜0.01);Fisher分级≥Ⅲ级血管痉挛发生率明显高于Fisher分级Ⅰ-Ⅱ级,差异有统计学意义(P＜0.01);白细胞计数＞ 15×109的患者脑血管痉挛发生率(41.9％,18/43)明显升高(P＜0.05).结论 Hunt-Hess分级≥Ⅲ级、Fisher分级≥Ⅲ级、白细胞计数增高是蛛网膜下腔出血后脑血管痉挛的危险因素.     

107例动脉瘤性蛛网膜下腔出血患者预后的多因素分析

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者的临床特点及其与预后的相关因素。方法回顾性分析大连医科大学附属第二医院神经外科2012年1月至2015年10月收治的107例SAH患者,根据GOS评分将病例分为预后良好组及不良组,采用单因素分析及对多因素Logistic回归分析,探讨上述各因素对预后的影响。结果全部107例患者经单因素分析显示,诱因、动脉瘤大小、Hunt-Hess评分、脑血管痉挛与患者预后明显相关(均P0.05)。多因素Logistic回归分析显示,诱因(P=0.026)、动脉瘤大小(P=0.002)、Hunt-Hess评分(P=0.016)及脑血管痉挛(P=0.003)为影响a SAH患者预后的独立危险因素。结论 a SAH患者的发病诱因、动脉瘤大小、Hunt-Hess分级和脑血管痉挛是影响患者预后的危险因素。     

动脉瘤性蛛网膜下腔出血患者认知功能研究

目的通过对动脉瘤性蛛网膜下腔出血患者认知功能的动态评估,探讨认知功能变化的临床意义。方法选择颅内前循环动脉瘤100例,并经血管内治疗或开颅夹闭处理。在入院时、出院时和出院后2月以简易智能量表等评估患者的认知功能。结果100例动脉瘤性蛛网膜下腔出血患者认知功能损害率入院时37.0%,出院时60.0%,出院后2月38.0%;出院时认知功能损害率高于入院时（P〈0.01）和出院后2月（P〈0.01）;认知功能损害主要反应在注意力和计算力、短程记忆和反应速度等方面;血管内治疗组和开颅夹闭组出院时和出院2月时认知功能损害率均差异显著（P〈0.05）。结论动脉瘤性蛛网膜下腔出血患者在不同时间段存在不同程度的认知功能损害,前瞻性预防和外科处理措施的改进能提高该类患者的生活质量。     

Neuropsychiatric disturbance after aneurysmal subarachnoid hemorrhage

Although aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 3–5% of all strokes, a high degree of morbidity has been reported in this relatively young subset of patients. Neuropsychiatric disturbance has often been neglected in these reports. We aimed to investigate the pattern and pathological factors of chronic neuropsychiatric disturbance in aSAH patients. This cross-sectional observational four-center study was carried out in Hong Kong. Neuropsychiatric outcome (Neuropsychiatric Inventory Chinese Version [CNPI]) assessments were conducted cross-sectionally 1–4 years after ictus. Pathological factors considered were early brain injury as assessed by admission World Federation of Neurosurgical Societies grade, aneurysm treatment (clipping versus coiling), delayed cerebral infarction, and chronic hydrocephalus. One hundred and three aSAH patients’ spouses or caregivers completed the CNPI. Forty-two (41%) patients were reported to have one or more domain(s) of neuropsychiatric disturbance. Common neuropsychiatric disturbance domains included agitation/aggression, depression, apathy/indifference, irritability/lability, and appetite/eating disturbance. Chronic neuropsychiatric disturbance was associated with presence of chronic hydrocephalus. A subscore consisting of the five commonly affected domains seems to be a suitable tool for aSAH patients and should be further validated and replicated in future studies.     

动脉瘤性蛛网膜下腔出血后慢性脑积水的诊治

目的探讨动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积水的诊断与治疗方法。方法回顾性分析33例经手术治疗的aSAH后慢性脑积水患者的临床资料。结果治疗后随访6月～2年,按GOS评分,恢复良好27例,轻残3例,重残2例,死亡1例。结论慢性脑积水是aSAH后的常见并发症,脑室-腹腔分流术是aSAH后慢性脑积水的有效治疗方法。