脑动静脉畸形破裂脑内出血22例分析

Analysis on 22 cases of intracerebral hemorrhage induced by cerebral arteriovenous malformation

目的 探讨在基层医院脑血管造影条件不完善情况下脑动静脉畸形破裂出血的诊断及治疗。方法 对我科2002年1月至2003年8月收治的22例脑动静脉畸形破裂出血病人与同期收治的60例高血压脑出血病人从年龄、血肿部位及形态、出血后血压变化及应用甘露醇是否有效几方面作一回顾性对比分析。结果 我们发现脑动静脉畸形出血病人平均年龄低,出血部位多在皮层下,形态不规则,呈弧形凹入或尖角形,出血后血压正常或一过性收缩压增高,用甘露醇后可下降。结论 在基层医院,无脑血管造影条件下,脑动静脉畸形出血术前可根据病人年龄、出血部位、血肿形态、以及出血后血压升高用甘露醇是否有效做出初步判断,术中多数可确诊。治疗上需根据病人意识情况和血肿量多少选择是否保守治疗或手术。手术治疗是可靠的方法,但由于手术前无脑血管造影,术后致残率较高。

Objective To discuss the diagnosis and treatment of intracerebral hemorrhage by arteriovenous malformation (AVM) without digital subtraction angiography (DSA) in the basic-level hospital. Methods A retrospective analysis in view of age, position and shape of the hematoma, blood pressure changes after hemorrhage and therapeutic efficacy of mannitol was performed to compare 22 cases of AVM-induced intracerebral hemorrhage with another 60 cases of hypertension-induced one, all admitted into the hospital simultaneously from January 2002 to August 2003. Results The AVM-induced intracerebral hemorrhage presented such features as small age, subcortical hematoma, irregular formation, normal blood pressure after hemorrhage or abnormal transient systolic pressure which were promoted through using mannitol. Conclusion In basic-level hospitals without DSA, AVM-induced hemmorrhage can be confirmed just relying on patient' s age, position and formation of hematoma and increase of blood pressure by using mannitol. Final diagnosis can be confirmed in operation. Whether it needs operation or not may depend on the patient' s consciousness and hematoma capacity. The surgical treatment is a dependable method, but deformity is higher because no DSA is available in preoperation at the basic-level hospitals.