老年人自发性蛛网膜下腔出血治疗方法选择与预后探讨

The Options of Therapeutic Methods for Spontaneous Subarachnoid Hemorrhage and its Relevance to Prognosis in Elderly Patiens

目的:探讨老年人自发性蛛网膜下腔出血的治疗方法选择与预后的关系。方法:选择本院1993—06～1999—06收治的60岁以上老年人自发性蛛网膜下腔出血共64例,男26例,女38例,均行头颅CT证实蛛网膜下腔出血(不合并脑内血肿);腰穿呈血性脑脊液,40例行DSA检查,动脉瘤31例,其中后交通动脉瘤14例,颈内动脉床突上段动脉瘤7例,前交通动脉瘤6例,大脑前动脉瘤1例,右小脑后下动脉瘤1例,左大脑中动脉水平段分叉动脉瘤1例,基底动脉分叉部动脉瘤1例;动静脉畸形5例,其中右顶脑动静脉畸形2例,右基底节动静脉畸形1例,小脑动静脉畸形2例;Moyamoya病1例;动脉硬化3例。内科保守治疗29例,血管内治疗25例,手术夹闭及切除病灶10例。结果:内科保守治疗组死亡8例,死亡率27.6％,血管内治疗死亡2例,死亡率8％,手术夹闭及切除病灶组死亡1例,死亡率10％。结论:老年人自发性蛛网膜下腔出血以动脉瘤常见,传统的内科保守治疗死亡率高,血管内治疗或手术是治疗老年人自发性蛛网膜下腔出血有效的治疗方法。

Objective in this paper, the authors summarized the outcomes of treatment with differnt methods in the management of spontaneous subarchnoidal hemorrhage (SAH) in the elderly patients. Methods From 1993 - 1999, 64 cases with SAH were admitted (male, 26; Female, 38). The diagnoses of these patients were established on CT findings. Of 40 cases, who received the DSA, 31 were confirmed that their SAHs were attributable to the presence of aneurysms. AVMs were found in 5, Moyamoya' s disease in 1 and arterial sclerosis in another 3 patients. Of the 64 cases, 29 received conservative treatment, 25 endovasecular embolization, another 10 patients surgical clipping and/or radical resection. Results Eight patients died in the conservative group (8/29), 2 in the embolization group (2/25), and 1 in the clipping and operative group (1/10). Conclusions Aneurysms were usually the cause of spontaneous SAH in elderly patients. Traditional conservative treatment was often accompanied by high mortality. The authors concluded that, in dealing with spontaneous SAH in elderly patients, ednovasculization or surgical intervention was the most effective therapeutic method.