外伤性蛛网膜下腔出血患者血管痉挛状态的前瞻性临床研究

A preliminary study on cerebral vasospasm patients with traumatic subarachnoid hemorrhage

目的 探讨t-SAH患者中脑血管痉挛（CVS）的发生率、CVS的时间窗及危险因素.方法 前瞻性地对2007年6月至2008年12月期间绍兴县中心医院神经外科收治的t-SAH患者临床资料进行收集、分析,并于患者入院7 d内每天和第14天通过TCD观察大脑中动脉的血流动力学变化,以MCA平均血流速度（VmMCA）≥120 cm×s-1为CVS的标准,统计t-SAH患者中CVS的发生率、CVS的时间窗及相关的危险因素.结果 共98例t-SAH患者纳入本研究,CVS发生率为41.8%（共41例）,其中GCS≤8分患者的MCA平均血流速度明显高于GCS≥9分患者;t-SAH积血Hijdra法计算6分以下45例（45.9%）中有2例（4.44%）,6～13分31例（37.8%）中有9例（29.0%）,13分以上22例（20.0%）中有8例（36.4%）发生CVS.手术组中37例（37.8%）中有13例（35.1%）发生重度CVS,通过对症治疗仍出现4例局部脑梗死,并入院3 d后的MCA平均血流速度明显高于非手术组.结论 t-SAH患者的原发伤程度、出血量及部位、手术操作等是导致CVS的主要危险因素。

Objective To analyze the incidence of cerebral vasospasm （CVS） in patients with traumatic subarachnoid hemorrhage （ t -SAH）, time windows of CVS as well as the risk factors. Method A total of 98 pa tients, with t -SAIl admitted from June 2007 to December 2008, were enrolled for this prospective study. The hemodynamics of middle cerebral artery （MCA） in these patients was monitored with trancranial Doppler （TCD） daily for 7 days after admission and on the 14th day of hospital stay. The incidence of cerebral vasospasm （CVS） in patients with traumatic subarachnoid hemorrhage （t-SAH）, time windows of CVS as well as the risk factors were analyzed. Results Of them, 41 patients （41.8 % ） had CVS. The flow velocity of MCA in patients with GCS≤ 8 was significantly higher than that in patients with GCS ≥9. Classified by t-SAH cumulative blood Hijdra method, 2 （4.44%） of 45 patients（45.9%）with scores 6 or less,9 （29.0%）of 31 patients （37.8%） with scores 6- 13, and 8 （36.4 % ） of 22 patients （20.0 % ） with scores 13 or more had CVS. Severe CVS occurred in 13 （35.1% ） of 37 surgical patients （37.8%）, and local cerebral infarction occurred in four surgical patients after symptomatic treatment. The flow velocity of the MCA was significantly higher in surgical patients than that in non-surgical patients 3 days after admission. Conclusions The severity of original trauma, bleeding, location of t-SAH and operation are the major risk factors to lead to CVS in patients with t-SAH. Attention should be paid to those risk factors during the treatment of patients with t-SAH.