脑动脉瘤破裂出血的急诊栓塞治疗

目的探讨脑动脉瘤破裂急性出血期经血管内栓塞治疗的效果。方法对出血后3天内的51例脑动脉瘤急诊行全脑血管造影,在确认责任动脉瘤后即用可脱螺旋圈栓塞。同时重视控制体循环血压,防治脑血管痉挛等措施。结果50例栓塞手术成功;4例术中动脉瘤出血和血管痉挛加重于术后遗留有不全偏瘫。2例因术前Hunt-Hess计分5级,术后病情未缓解5天内死亡。48例经随访6个月~3年未发生再出血情况。结论脑动脉瘤破裂出血后可以尽快栓塞治疗,应用降压和扩血管等相关措施有助于改善治疗效果。

Emergency embolizing therapy for hemorrhage due to rupture of intracranial aneurysm

Objective To evaluate the endovascular embolizing therapy of ruptured cerebral aneurysm in early bleeding period.Method Emergency DSA for 51 cases with cerebral aneurysms within 3 days after bleeding were performed.Criminal aneurysms were immediately embolized with detachable coils affirmed by angiography.At the same time,attention was paid to controlling blood pressure of systemic circulation and measures of prevention and treatment of cerebral vasospasm.Results Embolization was successful in 50 cases.Four cases suffered from incomplete hemiplegia due to aneurysm bleeding and vasospasm of parent artery during embolizing procedure.Two cases with Hunt-Hess grade-Ⅴ before treatment died within 5 days because the patients' states were not improved after embolization.There was no rebleeding in 48 cases during follow-up for 1/2 to 3 years.Conclusion Ruptured cerebral aneurysms can be embolized as fast as possible.The therapeutic efficacg can be improved by controlling blood pressure and cerebral vasospasm.