老年蛛网膜下腔出血的分析

Clinical Study of Subarachnoid Hemorrhage(SAH) of the Elderly

目的 分析老年蛛网膜下腔出血（SAH）的临床特点及防治措施。方法 回顾分析80例老年SAH的病因和临床特征，误诊原因。结果 老年组80例中头痛48例（60％），恶心呕吐24例（30．0％），意识障碍者73例（91％），脑膜刺激征53例（66．2％），肢体瘫痪32例（40％），癫痫5例（6．2％），动眼神经麻痹5例（6．2％），颅内压在140—170mmH2O者68例（84．9％）；非老年组头痛72例（90．0％），恶心呕吐58（72．5％），意识障碍者11例（13．7％），脑膜刺激征67例（83．7％），肢体瘫痪9例（11．2％），癫痫13例（16．2％），动眼神经麻痹5（6．2％），颅内压在210～400mmH2O者67例（83．8％）。结论 老年SAH的主要病因是高血压及动脉硬化病，临床上年龄越大，头痛及恶心呕吐等症状越轻，出现意识障碍约占73％以意识模糊较多见。脑膜刺激征不典型，双下肢病理反射常阳性，癫痫发作较中青年少见，早期识别SAH的临床特征是防治误诊的关键。

Objective Analyse the clinical characteristics and remedial measures on subarachnoid hemorrhage（SAH） of the elderly. Methods Retrospection 80 cases old age SAH and analyse the cause of disease,clinical characteristic and misdiagnose cause. Results In 80 cases of old age SAH,48 cases were headache（60% ） , 24 cases were nausea and vomitting （30.0%） , unconsciousness patients have 73 cages （91% ）, meningeal irritation sign 53 cases （ 66.2 % ）, the body paralysis 32 cases （40%）, epilepsy 5 cases （6.2%） ,oculomotor palsy 5 cases（6.2% ） ,and encephalic pressure increases to 140 - 170ram water columns patients have 68 cases（84.9% ） ; In the young group SAH ,72 cases were headache（90.0% ） ,58cases were nausea and vomitting（72.5% ） ,unconsciousness patients have 11 cases（ 13.7% ） ,meningeal irritation sign 67 cases （83.7%） ,the body paralysis 9 cases （ 11.2% ）, epilepsy 13 cases （ 16.2% ）, oculomotor palsy 5 cases（6.2% ） ,and encephalic pressure increases to210 -400 mm water columns patients have 67 cases （83.8 % ）. Conclusion The main cause of old age SAH was the hypertension and the arteriosclerosis, in clinic, the age more older the symptoms of headache and naupathia vomit more slighter, about 73% patients and mostly was consciousness faint. The symptoms of stimulate meninges was unrepresentative,two sides pathological reflection was often positive, the failing sickness paroxysm was few than younger,distinguished the clinical characteristic of SAH in early phase is the key of prevent misdiagnose.