自发性蛛网膜下腔出血脑血管造影与治疗方案选择

The Alternative of Therapeutic Method and Brain Angiography in Spontaneous Subarachnoid Hemorrhage

目的：对住院204例自发性蛛网膜下腔出血（Subarachnoid hemorrhage，SAH）中，161例做数字减影脑血管造影（DSA）检查者诊治行后谵性研究。方法：以2005年4月～2008年4月住院SAH204例患者做DSA161例，据检查结果诊治。对DSA检查率及SAH的DSA阳性率低和SAH后并发脑血管痉挛（Cerebral vessels spasm，cvs）诊断、规划治疗进行讨论。结果：DSA检查率占收治率78．9％。检出脑动脉瘤81例（50．3％）、脑动静脉畸形（AVM）24例（14．9％），颅底异常血管网病（moyamoya）1例（0．6％）；有高血压史DSA阴性的SAH22例（13．7％），无诱因DSA阴性的SAH33例（20．5％），比文献记载高；动脉瘤夹闭术43例、栓塞治疗23例，占发现动脉瘤的81．5％。脑AVM手术13例、栓塞5例、伽玛力治疗3例，手术占54．2％。预后GGS评估：动脉瘤手术及栓塞恢复良好62例（93．9％），死亡4例（6．1％）。AVM：良好9例，轻残4例，无死亡病例。未做外科干预治疗组，动脉瘤15例（6例好转，4例恶化，5例再出血死亡）。有高血压史DSA阴性的SAH22例及无诱因DSA阴性的SAH33例，执行内科治疗方案。GCS评估：35例好转，14例恶化，6例因再出血、肺部感染等并发症死亡。2例AVM（Ⅲ级）及1例moyamoya症状稳定。结论：客观认识DSA对SAH及CVS诊断和选择治疗策略有着积极性、决定性价值。抉择检查“时间窗”、提高DSA检查率、加强投照技术充分造影及读片质量，是DSA对SAH病因检出率提高的主要因素。积极外科干预，明识CVS及早发现，坚持“预防为主、防治结合、全程治疗、预防CVS并发症”，规范治疗方案，是降低SAH、CVS死亡及致残率的严守原则。

Objective： The data of 161 cases underwent digital subtraction angiography （DSA） were retro- spectively analysed in which 204 cases in hospital . Methods： Data were reviewed from 161 cases experienced DSA in 204 cases in our hospital from April 2005 to May 2008, all of this cases discussed according to DSA check- up ratio and CVS after SAH and made scheme to SAH. Results： 78 % patient suffered DSA in hospital and detected aneurysm 81 cases （50.3 % ）, brain arteriovenous malformation 24 cases（ 14.9 % ）, moya moya diseases 1 case（0.6 % ）, DSA checking negatively are 22 cases （13.7 % ） after SAH have hypertension history and 33 cases are negatively （20.5 % ） without motivation and numerical value are higher than documents record. Aneurysm clip are performed in 43 cases and embolotherapy in 23 cases which take 81.5 % in all aneurysm. Brain arteriovenous malformation operated in 13 cases which occupied 54.2 % and embolotherapy in 5 cases and γ- knife therapied 3 cases . Prognosis appraisal was made by GGS： cerebral aneurysm operation and embolotherapy cured 62 cases （93.9 % ）, died 6 cases （6.1% ） ; brain arteriovenous malformation regained fine in 9 cases, mild injury 4 cases and no death ; No surgery intervention group in 15 cases aneurysm patients resulted in 6 eases take a favorable turn and 4 cases got worse and 5 cases died due have hypertension history and 33 cases negatively without to rehaemorrhagia. 22 cases DSA checking negatively motivation to carry out medical treatment and made prognosis appraisal by GCS that 35 cases improved , 14 cases got worse and 6 cases died due to rehaemorrhagia and pulmonary infection. Symptom stabled in 2 cases arteriovenous malformation （4 degree） patients and 1 case moya moya diseases . Conclusion： DSA have affirmative value in SAH and CVS when you make diagnose and choose therapia strategy. To select suitable exam time and strengthen manipulating technique as well as examine quality can raise DSA isolating rate . Surgery interfere in SAH should in an early date and insist on precaution crucial, prevention and cure be binding , therapeutics maintenance in whole range , prevent complication of CVS and to specify therapeutic regimen can cut down death and physical disability ratio.