不明原因的蛛网膜下腔出血重复脑血管造影的探讨

目的探讨不明原因的蛛网膜下腔出血(SAH)患者重复脑血管造影的益处和危险性。方法回顾分析140例SAH患者154次(首次140例，重复14例)脑血管造影的结果及其并发症。结果首次造影发现动脉瘸107例(76％)，烟雾症2例，血管畸形1例。14纠重复脑血管造影捡查时发现前交通动脉瘸1例；12例进行了脑、脊髓MRI扫描，发现丘脑、脊髓血管畸形各1例、全部154次造影检查中，术后8h内死亡1例，脑梗死1例，血管痉挛6例，穿刺点感染2例，并发症比例4．2％(10／154)。结论首次脑血管造影检查时，若技术及设备优良，拍片仔细。结合CT MRI检查及临床特点，则重复造影不必进行；当首次造影结果无可靠，伴有脑血管痉挛或再出血者，重复脑血管造影才是合理的。

A Study on Repeating Cerebral Angiography in the Subarachnoid Hemorrhage of Unclear Causes

Objective To explore the benefit and danger of the repeating cerebral angiographhy in the patients with subarachnoid hemorrhage(SAH) of unclear causes. Methods The clinical data of 140 SAH patients underwent 154 times of cerebral angiography including 14 times of repeating cerebral angiography were retrospectively analyzed. Results The first cerebral angiography found 107 cases of aneurysm(76%), 2 cases of aerosolization symptom and one case of vaso-deformity, and the repeating cerebral angiography found one case of antero-traffic artery aneurysm. The cerebral and spinal MRI was performed in the 12 patients, and found one case of thalamic vaso-deformity and one case of spinal vaso-deformity. Among 154 times of cerebral angiography, there were one case of death after operation, one case of cerebral infarct, six cases of vasospasm, and two cases of infection at the puncturing point. The frequency of complications was 64%(10/154). Conclusion During the first cerebral angiography, if the technique and equipment were excellent, and combined with MRI and clinical parameters to do the analysis, the repeating cerebral angiography was unnecessary. When the first angiography is unreliable or the patients had vasospasm and re-hemorrhage possibility, the repeating cerebral angiography was reasonable.