非动脉瘤性与动脉瘤性蛛网膜下腔出血特点的分析

目的探讨非动脉瘤性与动脉瘤性蛛网膜下腔出血（aSAH）的临床特点。方法回顾性分析168例非aSAH和104例aSAH患者入院时的Hunt-Hess分级、CT检查（以德国Freiburg大学神经中心的标准,根据头部CT影像分型）、第1次全脑DSA检查、重复全脑DSA及短期和长期预后MRS（Modified Rankin Scale）评分等临床资料。结果①两组患者入院时的Hunt-Hess分级比较,差异有统计学意义,χ^2=74.023,P〈0.001。②两组CT分型比较差异有统计学意义,χ^2=117.486,P〈0.001。非aSAH和aSAH患者伴有脑室积血者分别为36.6%（41/112）和89.4%（93/104）,χ^2=72.254,P〈0.001;脑积水分别为34.8%（39/112）和74.0%（77/104）,χ^2=38.910,P〈0.001。③中脑周围型蛛网膜下腔出血和非中脑周围型蛛网膜下腔出血患者入院时,Hunt-Hess分级比较差异有统计学意义,χ^2=16.680,P〈0.01;经Spearman相关分析：入院时Hunt-Hess分级与CT分型之间无直线相关关系,r=-0.4,P〉0.05。④中脑周围型蛛网膜下腔出血患者脑积水和脑血管痉挛的发生率,分别为14.5%（8/55）和21.8%（12/55）,非中脑周围型蛛网膜下腔出血患者脑积水和脑血管痉挛的发生率,分别为54.4%（31/57）和42.1%（24/57）,两组比较,χ^2=19.575,P〈0.01和χ^2=5.283,P〈0.05。⑤168例非aSAH患者随访92例,MRS≤2分者占90.2%,中、重度残疾占3.3%;104例aSAH患者随访88例,MRS评分≤2分者占50.0%,中、重度残疾占34.1%,χ^2=8.42,P〈0.05。结论非aSAH比aSAH患者入院时Hunt-Hess分级低,并发症少、预后好,在中脑周围型蛛网膜下腔出血的患者中表现得更加明显。

Characteristic analysis of aneurysmal and nonaneurysmal subarachnoid hemorrhage

Objective To investigate the clinical features of aneurysmal subarachnoid hemorrhage （aSAH） and nonaneurysmal subarachnoid hemorrhage （SAH）.Methods The clinical data of Hunt-Hess grade, CT examination （according to the criteria of head CT typing from Neurocenter, Freiburg University, Germany）, the first and repeated global DSA as well as the short-and long-term modified Rankin scale （mRS） in 168 patients with nonaneurysmal SAH and 104 patients with aSAH at admission were analyzed retrospectively.Results There were significant differences between the two groups in Hunt-Hess grade at admission （χ^2 =74.023, P〈0.001）, and CT typing （χ^2 =117.486,P〈0.001）. The percentage of patients with SAH and aSAH complicated with intraventricular hemorrhage were 36.6% （41/112） and 89.4% （93/104）, respectively （χ^2 =72.254, P〈0.001）, and complicated with hydrocephalus were 34.8% （39/112） and 74.0% （77/104）, respectively （χ^2=38.910, P〈0.001）. There were significant differences in Hunt-Hess grade between perimesencephalic and non-perimesencephalic SAH at admission （χ^2 =16.680, P〈0.01）. According to the Spearman correlation analysis, there were no linear correlation between Hunt-Hess grade and CT typing at admission （r=-0.4, P〉0.05）. The incidences of hydrocephalus and cerebral angiospasm in patients with perimesencephalic SAH were 14.5% （8/55） and 21.8% （12/55）, respectively, and in patients with non-perimesencephalic SAH were 54.4%（31/57） and 42.1%（24/57）, respectively. There were significant differences between the two groups （χ^2=19.575, P〈0.01 and χ^2 =5.283, P〈0.05）. Ninety-two of the 168 patients with nonaneurysmal SAH were followed up,the incidence of patients with mRS scores≤2 was 50.0%, and with moderate or severe disability was 3.3%. 88 of the 104 patients with aSAH were followed up, with mRS scores≤2 was 50.0%, and moderate or severe disability was 34.1%（χ^2 =8.42,P〈0.05）.Conclusions The Hunt-Hess grade in patie