大脑中动脉动脉瘤破裂致蛛网膜下腔出血的新CT分型及其临床价值(附121例报告)

目的探讨大脑中动脉动脉瘤(MCAA)破裂后蛛网膜下腔出血(SAH)的CT分型方法及其临床价值。方法 1997年12月至2011年9月开颅夹闭破裂MCAA 121例。依据其SAH CT的特点分为两型,Ⅰ型为脑池出血型,70例;Ⅱ型为脑池出血伴脑实质或脑室出血型,51例。分析这种分型与术前Hunt-Hess分级及患者预后的关系。结果出院时按GOS评估预后,CT分型为Ⅰ型的70例患者中,治愈65例(92.9%),生活自理3例(4.3%),死亡2例(2.9%);51例Ⅱ型患者中,治愈36例(70.6%),生活自理9例(17.6%),重残4例(7.8%),死亡2例(3.3%);两者治愈率差异显著(P<0.01)。CT分型Ⅰ型患者中术前Hunt-Hess分级Ⅰ~Ⅲ级比例(97.1%,68/70)明显高于CT分型Ⅱ型患者(54.1%,28/51;P<0.01)。结论 MCAA破裂后SAH的CT分型与术前Hunt-Hess分级呈正相关,与病人的预后呈负相关。

New classification of subarachnoid hemorrhage according to CT image and its clinical value in the patients with ruptured middle cerebral artery aneurysms

ObjectiveTo explore a new classification of subarachnoid hemorrhage(SAH) induced by the ruptured middle cerebral artery aneurysms(MCAAs) according to its manifestations on CT image and its clinical value.Methods Clipping of aneurysms via the pterional approach were performed in 121 patients with ruptured MCCAs,in whom SAH was classified into 2 types according to the manifestations of the hemorrhage on CT image,i.e.typeⅠ(70 cases,57.9%) which meant the hemorrhage only in the cerebral cisterns and typeⅡ(51 cases,42.1%) which meant the hemorrhage in both the cerebral cisterns and parenchyma or ventricles.The relationship of the types with Hunt-Hess grades and the prognosis was analyzed.Results Of 70 patients with type Ⅰ SAH,68 belonged in Hunt-Hess gradesⅠ~Ⅲand 2 in gradesⅣ~Ⅴ.Of 51 patients with typeⅡSAH,28 belonged in Hunt-Hess gradesⅠ~Ⅲand 23 in gradesⅣ~ Ⅴ.Of 70 patients with typeⅠSAH,65(92.9%) were cured,3(4.3%) were moderately disabled and 2(2.9%) died.Of 51 patients with types Ⅱ SAH,36(70.6%) were cured,9(17.6%) were moderately disabled,4(7.8%) were severely disabled and 2(3.3%) died.There was significant differences in Hunt-Hess grade and the prognosis of the patients between types Ⅰ and Ⅱ SAH patients with ruptured MCCAs(P<0.01).Conclusions It is suggested that is good relativity between Hunt-Hess grades or prognosis and the new types of SAH in the patient with ruptured MCCAS,which may be used to assess the patients’disease conditions and predict the patients’prognoses.