蛛网膜下腔出血早期病因诊断和治疗

Early etiology diagnosis and treatment of subarachnoid hemorrhage

目的对蛛网膜下腔出血患者进行早期病因诊断,并针对病因进行治疗。 方法对138例经临床确诊的蛛网膜下腔出血患者,进行诊断性全脑血管造影,根据造影结果,分为开颅夹闭动脉瘤组(60例)、血管内治疗组(56例)和内科保守治疗组(22例)。 结果 138例患者中60例接受手术夹闭治疗,56例血管内介入治疗,22例内科保守治疗;4例死亡,134例痊愈。结论颅内动脉瘤是蛛网膜下腔出血最常见的病因,动脉瘤多位于前、后交通动脉,常为单发的中小动脉瘤。手术夹闭或介入栓塞治疗,疗效确切。

Objective To do the early etiologic diagnosis and to do the etiologic treatment in the patients of subarachnoid hemorrhage(SAH). Methods 138 patients with subarachnoid hemorrhage diagnosed by clinic examination were performed diagnostic angiography to find the etiology. DSA showed 120 cases suffered from a-neurysms, 12 cases suffered from multiple aneurysms. There were 108(81. 8% ) aneurysm on the Willis circle , 42 (31. 8% ) aneurysms on the anterior communicating artery (ACoA) and 66(50% ) aneurysms on the posterior communicating artery (PCoA). Neurologists, interventional doctors and neurosurgeon treated patients with the best methods according to the results of examination and the patients' status. Results 60 cases were received surgical treatment, 56 patients accepted interventional therapy and 22 cases were treated conservatively. 4 cases were dead. Conclusion The cerebral aneurysms are the most common cause for SAH. Aneurysms often origin from ACoA and PCoA , they are often single and small -to -medial size. Surgical and interventional treatment are effective.