动脉瘤性蛛网膜下腔出血的早期诊断及治疗

目的探讨动脉瘤性蛛网膜下腔出血（SAH）的早期诊断方法及治疗原则,并客观评价其治疗效果。方法对SAH患者采用影像学检查,结合病史、临床表现进行早期病因诊断;并对96例动脉瘤早期采用电解可脱性弹簧圈进行囊内栓塞;术后早期对症治疗。结果96个动脉瘤均被早期诊断并成功栓塞,其中100％闭塞者83个,95％闭塞者8个,90％闭塞者5个。术中并发动脉瘤破裂3例;并发脑血管痉挛5例;术后1例弹簧圈末端逸出;3例复发者均经二次补充电解可脱性弹圈（GDC）栓塞治愈。全组出现与栓塞技术相关的并发症9例;与SAH有关的永久性后遗症13例（13．5％）。Glasgow预后评分：Ⅰ级77例、Ⅱ级7例、Ⅲ级6例、Ⅳ级3例、Ⅴ级3例,死亡率3．1％。结论对破裂的动脉瘤性SAH进行早期病因学诊断,并采用电解可脱性弹簧圈进行动脉瘤囊内栓塞,术后积极对症治疗是提高动脉瘤性SAH治愈率和降低死亡率、致残率的重要方法。

The early diagnosis and therapy of aneurismal subarachnoid hemorrhage

OBJECTIVE: To discuss the early diagnostic methods and therapeutic principles of aneurysmal subarachnoid hemorrhage (SAH), and evaluate the therapeutic efficacy objectively. METHODS: Using neuro-imaging examinations combined with case history and clinical symptoms to make the early diagnosis of 96 case with aneurysmal SAH, and Guglielmi detachable microcoil (GDC) was utilized for early intracapsular embolization in the ruptured aneurysms. Efficient symptomatic treatment was done early after operation. RESULTS: All of 96 cases were early diagnosed and successfully embolized; Among them, the aneurysmal lumen was 100% occluded in 83 cases, 95% in 8 cases, 90% in 5 cases. There were 3 cases complicating with aneurysms rupture during operation, 5 cases with cerebral vasospasm. One case was affected by microcoil terminal escape after operation, 3 recurrent cases were all cured with secondary GDC embolization. There were 9 complications associated with embolization techniques and 13 cases (13.5%) occurring permanent sequelae associated with SAH. According to the Glasgow prognosis score, 77 patients got grade I, 7 grade II, 6 grade III, 3 grade IV, and 3 grade V. The mortality rate was 3.1%. CONCLUSIONS: To make early etiological diagnosis of the SAH patients, using GDC to embolize the aneurysms, and earlier efficient symptomatic treatment are important methods to improve the curative rate and reduce the mortality rate.